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P - 80649, REQUEST FOR ELECTRICAL INSPECTION - �C, /� ��/I � Minnesota State Board of Electricity �� `'f �� 1821 University Ave., Rm. S-128, St. Paul, MN 55104 . Phone (612) 642-0800 Home Duplex Apt. Bldg. Other: New Addn Commercial 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 this space and on the back of the white copy only. ��.-, PoR��� Calculate Inspection Fee - This Inspection Request will not be accepfed w Other Fee # Service Entrance Size Fe Mobile Home Park Stall 0 to 200 Amps Street Ltg./Traffic Sig. Above 200 Am s Transformer/Generator INSPECTOR'S USE ONLY Sign/Oudine Ltg. Xfmr. Alarm/Remote Control Swimming Pool I hereb certi thaf I ins the electrical Irriaation Boom o,.,,,.��:. the correcf fee: # Circuits/Feeders 0 to 100 Amps Above 100 Ai F� C�a' �J installation described herein on the dates stated THIS INSTALLATION MAY BE ORDERED DISCON��CTED IF NOT COMPLETED WITHIN 18 MONTHS. OFFICE USE ONLY This request void 18 monfhs (rom validation daffi prinfed in fhis box. I I�II II III II III II III II III II�MIN II III I� lll I I�I •�J� -�a * 0 6 6 4 3 4 2 3* ,`l3� PLEASE PRINT OR TYPE �f Requesf D-fe �`�� Rough-in inspecfion required$ es ❑ No Inspecfion Olher Than RougMn: eady Now ❑ Will Call r �You musf call ihe inspeclw when ready) Date Ready: I, �licensed contractor ❑ owner hereby request inspection of the above elecfrical work at: Job Address (Streef, Box, or Rou�e No.� Ciy Zip Code � � t '' 4 Secfion No. Township Name or No. Rarge No. Fire No. County 0 Power Supplier No. il Conhacto� (Company NameL Conhacfor License No. � �nE L� n� � Ltc� CJ�o �3� Addreu �Conhaclor or Owner Performing Insfallafion� . 5 R� 1• C, E . Sign (Conha Owner P rming Insfallafion) A�! {�� p �G� ( 1 j � 1A-11 8/96 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY �Ol � ..