P - 83749REQUEST FOR ELECTRICAL INSPECTION ,�
/I C] �� C] C/I Minnesota State Board of Electricity 5
�' J J J�'f 1821 University Ave., Rm. S-128, St. Paul, MN 55104
• , Phone(612)642-0800
Hv�me Duplex Apt. Bldg. Other. New Addn
Commercial Ind ial Farm Remod Re ai
Air Cond. tg. Equip. VVater Htr. Load Mgmt. Other:
Range � Elec. Heat Temp. Service
"X" abov e work covered by this request. Enter remarks in this space and on the back of the white copy only.
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # Serv'ce Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park $tall to 00 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Abov 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TAL .GO
Sign/Outline Ltg. Xfmr.
5�--
Alarm/Remote Control
Swimming Pool
I hereb certi ihaf I ins ed ihe elechicd installation described herein on the dates stated
Irri9ation Boom Rough-In �' p�r�r
Special Insp r'' � _ ' � � � `--�'--_''-- /J lt �c�. ��
Final �
Investigative Fee Q — �j
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 mon}hs from validafion date prinfed i is box.
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Request Date Rough-in inspection required? Yes ❑ No Inspection Other Than Rough-In: ❑ Ready Now ❑ Will Call
�� (You must call the inspector when ready) Date Ready:
I, icensed contractor ❑ owner hereby request inspection of the above electrical work at:
lob Address (Street, Box, or Route No.� Ci � Zip Code
l� 3 C. I�C 12 � b C.�E?
Secfion No. Township Name or No. Range No. Fire No. Coun .
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���/'ry"t Phone No.
Mailing
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Confractor (Company Name) Conhactor License No.
CITIES ELFCTDrn .....
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C�Wqe�PgrForming Insfallofion� - l Phone No.
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STA?E BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY