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REGIUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electriciry
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone(612)642-0800
n+4,o�• , New
Indushial Farm
Htg. Eq ' Water Htr. Load Mgmt. Other:
Rang Elec. Heat Temp. Service
:over this request. Enter remarks in this space and on the back
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copy only.
Calculaie Inspection Fee - This Inspection Request will not be accepfed without ihe correct fee:
Other Fee # Service Entrance ize Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 00 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TQTAL �
Sign/Outline Ltg. Xfmr. ��S
Alarm/Remote Control
Swimming Pool
I hereb certi that I ins ected �e elechical installation described herein on the dates stated
Irri9ation Boom Rough-In _ DO��/
Speciol Inspectio � .
Final � � rC�
Imestigative Fee
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS_
OFFICE USE ONLV This requesf void 18 monfhs from validation date prinfed in this box.
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�K � 4 9 8 9 E+ 7 9* PLEASE PRINT OR TYPE �5 '`��
Request Dafe Rough-in inspection required? Yes ❑ No Inspeclion Other Than RougMn: ❑ Ready Now ❑ ill Call
/,,. � (You must call fhe inspector when ready� Date Ready:
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I, icensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address freet, Box, or Roufe No. /��} ,��. City Zip Code
c.J �-�V �
Section No. Township Name or No. Range No. Fire No. County �� l
Power
Name)
Mailing Addres�(tf[�'QF�1�Cr P�jorrt�l�4jl�at�l
453-3110
Phone No. �
No. Master Lic. No.
Phone No.
OF YELLOW COPY