P - 82810REQUEST FOR ELECTRICAL INSPECTION - ��..
5 2 3��- 8 9 3 Minnesota State Board of Electricity
, 1821 University Ave., Rm. S-128, St. Paul, MN 55104
, Phone (612) 642-0800
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Re air I.
Air Con Htg. Equip. Water Htr. Load Mgmt. Oiher:
ryer � Range Elec. Heat Temp. Service
"X" above th work covered by this request. Enter remarks in this space and on ihe back of the white copy only.
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Calcuiafe lnspecfion fee - This lnspec6on Request will nol be accepted without the correci fee:
Other Fee # Servi e Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to Amps 0 ro 100 Amps o0
Street Ltg./Tra$ic Sig. Above 200 Am s Above 100 Am s
Transformer/Generator INSPECTOR'S USE ONLY TO
Si n/Oudine Lig. Xfmr.
Alarm/Remote Confro) � ��
Swimming Pool
I hereb certi tlwt I in the elechical inslallation described herein on the dales staled
Irrigation Boom Rough-In Dare
Speciallns i
Investigative FMaI ���
THIS INSTALLATION MAY BE ORDERED D13CONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This reqwst void 18 months 6om volidafion date printed in this bmc.
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* � 5 2 3$ 9 3 �a * PLEASE PRINT OR TYPE
Request fe Ro h-in ins on r uired$ .
�� ug pecfi eq ❑ Yes p No Inspecfio� Olher Than RougMn: ❑ Ready Now ��II Call
�D (You must call the inspector when ready) Date Ready: � �
,� licensed conhactor ❑ owner hereby request inspection of the above electrical work at:
Job Address (S �, w Rou .) CiH� J Zip Code
G/�d� /�!/e 2 iQ�� ' �
Section No. Township Name or No. Range No. Fire No. Couny
Occupanf P e No.
l/`i ��c a � J`— 02�
Power Supplier Address
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Elechiwl Contracror mpany Name) Contractor ticense No. Masfer lic. No. (Planf Elect. Only)
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Mailing Address (Contraclw w Owner P�rming Inslall 'on) ' / C. � ��
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Authorized Signature (Conhacior or Owner Perfor I�N�O� O Phone No.
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E&00001 A-11 8/96 �ATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY