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P - 82729REQUEST FOR ELECTRICAL INSPECTION 5 6 5- V J J � Minnesota State Board of Electricily 1821 Universiiy Ave., Rm. S-128, St. Paul, MN 55104 � Phone (612) 642-0800 Home Duplex Apt. Bld . Other: New Addn Commerciai Indusfrial 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 requesL Enier remarks in this space and on the back of the white copy only. ���p�.�� ,���t+n,�,,� ���r�.a, ��,.v �1t�73 Calculate lnspection fee - This Inspection Request wiU not be accepied 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 S+g. Above 200 Am s Above 100 Amps Transformer/Generator INSPECTOR'S USE ONLY TOTAL me ug. xrmr. mote Confrol � Pool � Boom i that I inspected the elechical inslallation described herein on the dates oa�e THIS INSTALLATION MAY BE ORDERED DISCONI�ECTED IF NOT COMPLETED WlTHIN 18 MONTHS. OFFICE USE ONLY This requesf void 18 months from validafion date printed in Ihis box. I���I�II�II�lI���I I�� • ��� IIIIIIIIII���I�I * 0 5 6 5 8 5 9 6* ��� PLEASE PRINT OR 7'YPE R��� �O� Rou F�in ins e� g pection required8 ❑ Yes ❑ No Inspecfion O�er Than Ro�$Mr: O Reody Now � yy;l! Call � L� � Z��(� �You must call the inspector v✓hen ready) pa� R��,: q��n �G T I, �licensed conhactor ❑ owner hereby request inspection of the above electrical work at: 1ob Address �streer, Box, or Ra,1e No.) C�y 6 �t � I Z;P� /1�2T4tr2 Si N.• �2�A1,� SecTion No. Tovmship Name w No. Range No. Fire No. [ti�..n. Occupont Phone No. h^�.l,G�� �zr• �,��c. S7I_ r� s���� . . . .al Con� r (� �ny Name) I --.-` �:.'i!W rl,t��tt�.L GaNS�— G� � Address (Conhactor or Owner Performing InsfallaKon) �25 N. 2...yC �+ v� N zed SignaNre Conhacfor w ner PerForming Instoll�ion) IiA-11 8/96 pT� gOARD COPY - SEE I Conkocfor License �Ac 0�2 �-n. . SS�r l �� Lic. �_ I St8— d6S8 ON BACK OF YELLOW COPY