P - 83032REQUEST FOR ELECTRICAL INSPECTION -� �
5��� C Z(i � Minnesota State Board of Electricity
.
J � 1821 University Ave., Rm. S-128, St. Paui, MN 55104
Phone (612) 642-0800 '�'
, �.
� Home Duplex Apt. Bldg. Other: (,,n New Addn
Commercial lndustrial Form �� J'� Remod e ir
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this requesi. Enter remarks in this space and on the back of the whiie copy only.
Colculaie Inspection Fee - This Inspection Reques► will not be accepted withoui the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street ltg./Traffic Sig. Above 200 Am s Above 100 Ai
Transformer/Generafor INSPE�S USE ONLY TOT�
Sign/Oudine ltg. Xfmr. �� �
Alarm/Remote Conhol
Swimming Pool
I hereb certi ihat I in the e instalkAion dexribed herein on Ihe dah
Irriqation Boom e,,,,�„
Fee
�• J�
Special Ins �
Firal
Investigative F ' •
_THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MON S.
OFFiCE IISE ONLY This requeat vad 18 months kom validafion date printed in this box.
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* � 5 3 2 5 1 9 6* PLEASE PRINT OR TYPE
Requesf Date Rough-in inspecfion required? ❑ Yes
8� I/ � G, ❑ No Inspec�ion Olher Than RougMn: ❑ Ready Now ❑ Will Call
� U (You musf call the inspector when ready) Date Ready:
I, ❑ licensed conhactor�owner hereby request inspection of the above electrical work at:
Job d (She�, Box, w R `//� Ciy Zip Code
,� 7'7 Z- �`- 5� �,� � c�% s�.s'�3 �
Seclion No. Township Name No. Range No. Fire No. CouMy
.�D � �.Sd,Cf -
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Power Supplier �� q��y �� Ql � . .
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dress (Conhacfor or � Pgrfonning In� �)
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�ignature (Con Mr or Owrrer Performi� InsP011af
11 8/9 gTATE BOARD COPY -
����� I P51'7/-DO��
INSTRUCTIONS ON BACK OF YELLOW COPY