P - 80688' REGIUEST FOR ELECTRICAL INSPECTION ��.
��� �� C Q O Minnesota State Board of Electricity
4nr J Q 1821 University Ave., Rm. S-128, St. Paul, MN 55104 -_
Phone(612) 642-0800
Home Duplex Apt. Bldg. Other: New Addn
Commerciol Industrial Farm Remod Re ir
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enier remarks in this space and on the back of the white copy only.
Calculate Inspection Fee - 7his Inspection Request will not be accepied wifhout the correct fee:
Other Fee # Service Entrance Size Fee Circuits/Feeders ee
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 U E ONLY � TOTAL
Sign/Oudine Ltg. Xfmr. ��J��� �¢ ���
Alarm/Remote Conhol
Swimming Pool I her certi thot I in the elechic stallalion described herein on the dales sfaled
Irrigation Boo � RougMn /� � � � � ,
$peciallnspectwn - ��
Final _ �L
Investigative Fee
THIS INSTALLATION MAY BE ORDERED DI NECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 monfhs kom validation date prinfed in this box.
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PLEASE PRINT OR TYPE
Requesf `D'a�fe Rough-in inspecfion required? Yes ❑ No Inspecfion O�er Than RougMn: ❑ Ready Now Will Call
�p ��'1' ' 9 �You must coll the inspecfor when ready) Dafe Reody:
I, ❑ licensed contractor� owner hereby request inspecfion of the above electrical work at:
Job Address �Street, Box, w Route No.) � Zip Code
;��bs �x,e�-n �► d I �y.�
Secfion No. Township Name or No. Range No. Fire No. Couny
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3 Q a�F � �k�
i� �T�)a�.ria C�.ecG` � � � - �g�f-?3SYf
Power Supplier Address `'
NS{� ��l �s ''VOr-r'��� �iSi��
Elechical Contrac�w (Company Name) Contractor License No. AAoster Lic. No. (Planf Elecf. Only�
0 W�IP�i�
Mailing Address �Conhacbr or Owner PerForming Insrollafion)
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Signature (Conh er PerFormi 1 Pfwne No.
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EB00001hi 1 8/96 �p� BOARD COPY - SEE INSTRUCiIONS ON BACK OF YELLOW COPY