P - 84682REGIUEST FOR ELECTRICAL INSPECTION -
�`�� �8 9 51 Minnesota State Board of Electricity
r 1821 University Ave., Rm. S-128, St. Paul, MN 55104
,.
Phone (612) 642-0800
Home Dup Apt. Bldg. Other: New Addn
Commercial Industria Farm Remod Re ir
ir Con . Htg. Equip. Water Hfr. Load Mgmt. Other:
Dryer �� Range � Elec: Heat Temp. Service
"X" obove the work cover y this requesi. Enter remarks in this space and on the back of the white copy only.
I Calculate Inspection Fee - This Inspection Request will not be accepied without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 00 Am 0 to 100 Amps
Sfreet Ltg./Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Gene�ator INSPECTOR'S USE ONLY T�T Q
Sign/Oudine Lfg. Xfmr. � �5 s �
Alarm/Remote Control
Swimming Pool
I hereb cerfi fhaf I ins ed fhe eleclri I inslallafion described herein on the dWes sfa�ed
Irrigation Boom R Mn
S�QCI4� �fIS�ECtI � � _ -�� � � . '� �� � •
Final
Investigative fee
THIS INSTALLATION MAY BE ORDERED DISCONNE_ __NOT COMPLETED WITHIN 18 MON HS.
OFFlCE USE ONLY This request void 18 months from validafion dale printed in this box.
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* 0 4 9 8 9 5 1 3� LEASE PRINT OR TYPE
Request Date R h-in ins fion r uired? Yes
°U9 P� eq ❑ No Inspecfion Olher Than RougMn: ❑ Ready Now ill Call
'p � �You musi call fhe inspecfor when ready) Dafe Ready:
I, icensed conhac►or ❑ owner hereby request inspection of the above elecfrical work at:
Job Address (Sh , Box, o,Route No.) City . Zip Code
/ (r-�--. -�►2� ,b � L'
Section No. ownship Name or No. Range No. Fire No. Coun �� ,
Power
A-11
Phone No.
(Company Name) � Conhactor License No. /�� �,
IES ELEC,iaC� INC, �
�"�4 ,6t3�810 �� � � �r � l)
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