P - 81037.
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Home Duplex
Commercial Industri
Air Cond Htg. Ec
Dryer Range
"X" above fhe work covered
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REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
182f University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800 '�'
Apt. Bldg. Other: New Addn
�I Farm Remod Re air
uip. Water Htr. Load Mgmt. Other:
Elec. Heat Temp. Service
by �his request.� Enter remarks in this space and on the back of the whiie copy only.
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Calculote Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTA�L ^ c
Sign/Outline Ltg. Xfmr. f�/. �C
Alarm/Remote Confrol
Swimming Pool
I hereb certi thaf I ins fed the elecfrical insMllafion described herein on the dates stated
Irriqation Boom R,,,,,,�.i„ �r�
Speciallnspec i'
Find Dafe� 2�� �
Investigative Fee
THIS INSTALLATION MAY BE ORDERED DISC ECTED IF NOT COMPLETED WITHIN.�$ MONT��_
OFFICE USE ONLY This request wid 18 months 6om validation date printed in this box.
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* 0 7 5 2 8 4 2 5* �jp�Z7�
PLEASE PRINT OR TYPE
Request Dute Rough-in inspection required8 ❑ Yes �No Inspecfion O�er Than Rough�ln: �'Ready Now ❑ Will Call
u�You must call ihe inspecfor when ready) Dafe Ready:
1, �licensed contractor ❑ owner hereby request inspection of the above elechical work at:
Job Address Sfreet, Box, or oufe No.) Cify Zip Code
6 8�1� ?� S T�UE �•^ r��� SS 3.Z
Section No. Township Name or No. Range No. Fire No. ounty n �
Occupant
��ixer d �tSa
Power Supplier
Phone
Conhactor License No.
G/�O ���
- S 7/ -� 7�S
Master Lic. No. �Plant Elect. Only)
�s (Conhacfor or Owner erForming Installafion� /
` �✓
ppNre �C nhacf or Owner Pe i g Installation) � ;` Phone Nc
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8/ 6 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY