P - 80825RE(IUEST FOR ELECTRICAL INSPECTION
8��- 5 9 5� Minnesota State Board of Electricity
1821 University Ave Rm S-128 St Paul MN 55104 �:
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' Phone (6i2) 642-0800 ���
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Re air
ir C�1 . 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.
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Calculate Inspection Fe - This Inspecfion 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
Sheet Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Tra�sforn5er/Ge�lerator INSPECTOR'S USE ONLY ,� _ TOTAL
Sign/Outline Ltg. Xfmr. '� 05�
Alarm/Remote Control
Swimming Pool
I hereb ceni ihat I ins ted the elechical fnstallafion described herein on the dales stated
Irrigation Boom eooyMo pa�e
Specia{ Inspect
Final
Investigative Fee �.1„ � c� +„6' . E�
THIS INSTALLATION MAY BE ORDERED DISCO TE� IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months 6om validation date printed in ihis box.
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PLEASE PRINT OR TYPE
Requesf Date Rough-in inspection required$ ❑ Yes o Inspection Other Than RougMn: �ReatSy Now � Will Call
�' � Z9 � q �You m�st call the inspecfor when ready� Date Ready:
I, �licensed conhactor ❑ owner hereby request inspection of the above electrical work at:
lob Address (Sheef, Box, or Route No.) City Zip Code
$ecfion No. � Township Name or No.
Phone No.
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Power
Elecfricnl Confracfor (Company Name� . Conhncfor License No. Master Lic. No. �1
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Mailing Address (Conhacfor or Owner Performing Insfallafion)
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Authorized Signature �Conhacbr or Owner Performing Phone No.
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B-00001 A-I 1 8/96 SiATE BOARD COPY - SEE INSTRUCTI NS ON BACK OF YELLON' �