P - 84407\�� REGIUE�, ELECTRICAL INSPECTION
� IIIIIII�����1� MinnesotaState.AardofElectricity `�
* � 3�� q��� 4* 1821 University Ave., Rm. S-128, St. Paul, MN 55104
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Phone (612) 642-0800 ����
ome Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other: ,
Dryer Ran e Elec. Heat Tem . Service
"k' above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
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Calculate Inspection Fee - This Inspection Request will not be accepted withouf the correct fee:
Olher Fee �X Service Enirance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
$treet Ltg./Traffic $ig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
Sign/Outline Ltg. Xfmr. � �
Alarm/Remote Control
Swimming Pool �� ! Z_ j� � F�
I hereb certi that I ins ected the ele rical installa}ion described h n the 8ates stdind
Irrigation Boom Rou h-In
Special Inspe ' 9 n� Dafe � A
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Investigative F F��al � _ � � j
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
319 � O 2 O � OFFICE USE ONLY This request void 18 months from volidation date printed in fhis box.
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PLEASE PRINT OR TYPE
Req�u �t Daie ,�� Rough-in inspedion required2 es � No Inspection Other Than Rough-In: � Ready Now ill Call
� (You must call the inspecfor when ready) Date Ready:
I, icensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Roufe No.) Ciy � Zip Code
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Swii�n No. Townshio Name or No_ Ranae No. Fire No. unly
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Power 5� lie`Ii���,/`_ _ _
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Eledriwl Conhacior (Company N me
Meilina AddreaS�{Gontrad r or Ownei
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Addre�:�
Installation)
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Phone No.
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>-10 6/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY