P - 81313REQUEST FOR ELECTRICAL INSPECTION ��
��^�� �^ O Minnesota State Board of Eleciricity
� y 1821 Universiry Ave., Rm. 5-728, St. Paul, MN 55104
� Phone (612) 642-0800 "�'�1°°"
Home Duplex Ap�. Bldg. Other: New Addn
Commercial Industrial Parm Remod Re air
Air Cond. Htg. Equip. Woter Htr. Load Mgmt. Other.
Dryer Range Elec Heat Temp. Service
"X" abore the work cove�ed by this request ENer remarks in this spoce and on the back of fhe whife copy only.
G✓i.e�ti� OF �dd; r;o.v rv �eA,e o� f�r�
culate Inspecfion Fee - This lnspection Request will nor be accep�ed wifbout fhe correcf fee:
Other Fee # Service Ent2nce Size Fee M Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 ro 100 Amps �
Sheet Ltg./Tmffic Sig. A6ove 200_Am s Above 100�Amps
T.....�F...mer/C:oncmfnr WSPECTOP'SUSEONLV T�TA��� �
$lgn/Outline �ig. XSmr. — �
Alarm/Remote Confrol
$Wimmin9 Poo� 1 here6 ce�� �a� � Ins ened tl�e elecnic - smllonan dmcribed he�ein on ihe dmes z�aed
Irrigafion RoughJn
Special Ins i ' � � �__
� ° . /G_ p,
Investigative Fee �
_ I._
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requesr �oid 18 monrhs 6om validoiion dale pnnted in this box.
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* 0 6 3 2 9 9 0 9� a��2'9
PLEASE PRINT OR TYPE
Requesl Da�e Rc�gh�in inspxiion required? Yes ❑ No inspenion Oiher Tlwn Raugh-In: ❑ Rmdy Now' WIII Call
�Yov must call Il�e inspacror when reodyl Dole Reody:
I,�licensed controctor ❑ owner hereby request inspection of fhe above electrical work ot
Job Address (SVeet, Box, w Rome No.) Gy Zip Code
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� Occupam
Name or No.
Phme No.
' License No.
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ar� rrormi�sbllpN�� �� ' I Phone No. G`�
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