P - 81506/ REQUEST FOR ELECTRICAL INSPECTION
7 eJ �- 3 7 6 Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104 �
Phone (612) 642-0800
Home Duplex Apt. Bldg. Other: New Addn
Commercial Indusfrial Farm Remod Re air
Air Cond. Htg. E uip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on ihe back of the white copy only.
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Calculate Inspection Fee - This Ins tion 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 $ig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
Sign/Oufline Ltg. Xfmr. �S SQ
Alarm/Remote Control
$wimming Pool
I hereb certi that I ins the elechical installation dexribed herein on the dates stated
Irrigation Boom Rougi.lo pa�
Special Ins ecti
Final p
Investigative F �29'�
IS INSTALLATION MAY BE ORDERED DI NECTED IF NOT COMPLETED WITHtN 18 MONTHS.
OFFICE USE ONLY This request void 18 monfhs from validation date prinfed in fhis box.
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PLEASE PRINT OR TYPE
Requesf Date Rough-in inspeclion required2 ❑ Yes ❑ No Inspecfion Olher Than RougMn: Ready Now 0 Will Call
��� • 9 (You musf call the inspecfor when ready) Dafe Ready:
I, icensed conhactor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sh f, Box, or Roufe No. City ZiP � {
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Seclion No. Township Name or No. Range No. iire No. County
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Occupant � Phone No.
6t.�c, i ��/— 3�9;�
R�c. iNe,
Master Lic. No. (Plant
Signature �Conkoctor ner Performing Installafi Phone No.
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1 1 8/96 STATE BO D OPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY