P - 83028REQUEST FOR ELECTRICAL INSPECTION
�� � �,, � � � � Minnesota State Board of Electriciry
. 1821 University Ave., Rm. S-128, St. Paul, MN 55104 �:
� Phone (612) 642-0800 ���
Home Duplex Apt. Bidg. Other: New Addn
C mmercial Industrial Farm Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in ihis space and on the back of the white copy only.
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Calculate Inspection Fee - I his Inspection Request will not be accepted withovt the correc► fee: ,
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Sfreet Ltg./Traffic $ig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
Sign/Oudine Ltg. Xfmr. 1 S• �
Alarm/Remote Confrol
Swimming Pool
I hereb certi that I ins ted the electrical installation described herein on the dales stated
Irrigation Boom Rouglfln pare
Special �nspec *'
Finol Da 2 . �
Investigative Fee ' �;— � a
THIS INSTALLATION MAY BE ORDERED DISCONNE TED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This rcqueaf void 18 months from validafion dafe prinfed in fhis box.
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P EASE PRINT OR TYPE
Requesf Daf� Rough-in inspecfion required$ ❑ Yes No Inspection Ofher Than RougM : Re� w❑ Will Call
(You must call the inspector when ready� Dafe Ready: 8
I, ❑ licensed contractor ❑ owner hereby request inspection of the above electrical work at:
�0�55 sh�/�x. a R� No,�_ /t, � ��" CGL� / Z' J��3
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Section No. Township Name or No. Range No. Fire No. County
Occupa��� Phone No. `� �
( �, .� 3
Power Supplier Address
EI hacfor �Company Name) . � Confmctor License No. Masier Lic. No. (Planf Elecf. Only)
�' � �i���G � / � o
Mailin Address (Conhactor or Owner performing Installatio �
�%� S �Li7 n S� v� ��, .
Au ri Sign r0 (Conhpcfor or Owner PerFormin nsfallafion) � C��( n e� p� No/' ���
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EBO0001 A-1 6/96 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY