P - 82134���-197 �
Home Duplex
Commercial Industrial
Air Cond. Htg. Equi
Dryer Range
"X" above the work covered 6
� T
REQUEST FOR ELECTRICAL WSPECTION
Minnesota State Board of Electricity �
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1821 University Ave., Rm. S-128, St. Paul, MN 55104 �'
Phone(612)642-08QQ
Apt. Bldg. Other: New Addn
Farm Remod Re air
Water Htr. Load Mgmt. Other:
Elec. Heat Temp. Service
request. Enter remarks in this space and on the back of the white copy only.
Calculate Inspection Fee - This Inspection Request will not be accepied withoui ihe correc► 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 �
Transformer/Generator iNSPecroR'S USE ONLY TOT L
Sign/Outline Ltg. Xf , �(` . Gh l( � 02 �!'��e �r � •
Alarm/Remote Co
Swimming Pool
I hereb certi ihat I ins the elechical installation described herein on the dates stated
Irrigation Boom RougMn Dare
Special Inspection !
Investigqtive Fee F��� l/- `%�2— ��e �i!-ac`
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN ONTHS.
OFFICE USE ONLY This requesf void 18 months from validation date printed in fhis box.
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;,* 0 8 0 2 1 9 7 4* ��•50
PLEASE PRINT OR TYPE
Requesf Date Rough-in inspection required? �Yes ❑ No Inspectio� Other Tha� Rough-In: ❑ Ready Now �� Will Call .
� ('� �You musf call the inspector when ready) Date Ready:
I, ❑ licensed contractor [�owner hereby request inspection of the above electrical work at:
Job ddress �Sheet, Box Route No.) Cily Zip Code
� (S� 2r �'.� o� ,3�-.
Section No. Township Name or No. Range No. Fire No. oun
• � o c. �.
Occupan� �Q � �� I � Phone No. � Q
�C -z..�' — (r'
Power Supplier ^ Addreu
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Elechicvl�Conhacror ICompanr Name1 _ Confracror License No. Master Lic. No. IPlant Elect. Only)
; r�( - ,
or Owner Pe inf
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STATE BOARD
%� -�d
SEE i STRUCTIONS ON BACK OF YELLOW COPY