P - 83957. RE(�UEST FOR ELECTRICAL INSPECTION
-/� o � Minnesota State Board of Electriciry
�} � O��� O ° i�21 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800
Home Duplex Apt. Bldg. Other: New
Commercial Industrial Farm Remod
ir Cond. ' Htg. Equip. Water Htr. Load Mgmt. Other:
ry Range Elec. Heat Temp. Service
,"X" above the work covered by this request. Enter remarks in this space and on ihe back of the white copy
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Calculate Inspection Fee - This Inspection Request will no► be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 00 Amps 0 to 100 Amps
Street 6tg./Traffic Sig. Abo 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOT�L y,� y�''
Sign/Outline Ltg. Xfmr. A"'
Alarm/Remote Control �� --
Swimming Poo)
I hereb certi that I ins cted the electrical installation described herein on the dates stated
Irrigation Boom RougfFln Da
Special Inspectio Z�J��
Final D
Investigative Fee � ",.��— �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validation date prinfed in this box.
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* � 4 9 8 9 6 � 4 xc PLEASE PRINT OR TYPE �Jf .,�
Reque/s�t Dafe Rough-in inspection required? Yes ❑ No Inspeciion Ofher Than Rough-In: ❑ Ready Now ill Call
Il.1 �p�q —9, (Vou musf call the inspector when ready) Date Ready:
I, licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address �Street, Box, or Route NL.) City � Zip Code
1�� C- F�12 t ST' � S�rr� �" �12 � io�.e ���
Section No. Township Name or No. Range No. Fire No. County J'�)
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Occu t Phone No.
1� O Ll.1/1/�'�
Power Supplier Address „
I Confracfor (Company Name�
CITIES FLECTRIC, INC.
Address IConhactor or ner^ehorminA In
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n�rho��Z�d
EB OOOOI A-11 8/96 STATE
CorAractor License No.
CA00381
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lion)
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C (/�S� (�CJ
Masfer Lic. No. �Plant Elect. Only)
No.