P - 83121� RE(�UEST FOR ELECTRICAL INSPECTION
6 ���� C� � Minnesota State Board of Efectricity
�� 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
Air Cond. Htg. E uip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by ihis request. Enter remarks in this space and on fhe back of the white copy only.
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Calculate Inspection Fee - This Inspection Request will not be accepted without fhe correct fee:
Other Fee # Service Entrance Size Pee # Circuits/Feeders Fee
Mobile Home Park Stall 9 to� 00 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S US� ONLY TOT.�AL '�
Sign/Outline Ltg. Xfmr. '� •� `'
Alarm/Remote Control S S �i
Swimming Pool
I hereb certi that I ins d the electrital installation described herein on the dafes stated
Irrigation Boom Ro�Mn p1 Da
Speciallnsp 'o "
Final re
Investigative • �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MOI�THS.
OFFICE USE OPILY This requesf void 18 months kom validafion date prinTed in this box.
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PLEASE PRINT OR TYPE
Req°es� �°fe Rou h-in ins ecfion re uired? es .
` g p q ❑ No Inspecfion Ofher Than Rough-In: ❑ Ready Now i a l
�–�3—� (You must call the inspector when ready) Date Ready: ..
I, icensed contractor ❑ owner hereby request inspection of the above electrical work at:
.bb Address �Shcet, Box, or Route No.) City Zip Code
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$ection No. Township Name or N Range No. Fire No. � County
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Occupant Phone No.
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Power Supplier � Address �
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Electrical Confracror (Company Name� Contracror License No. Master Lic. No. (Plant Elect. Only)
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Mailing Address (Contracfor or Owne� PerForming Insfallafion) � � - �
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Aufhorized Signafure �Co tor or Owner P rmi g InstallafionJ � 1'� � � Phone No.
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E&00001 A-1 1 8/96 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY