P - 8391749 -959 �
Home Duplex
Commercial Indns(
above
RE(IUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800 � `"'°'
Other: New Addn
Farm
Water Htr. Load Mgmt. Other:
Elec. Heat Temp. Service
request. Enter remarks in this space and on
Remod
white copy only.
Calculate Inspection Fee - This Inspection Requesi will not be accepted without the correci fee:
Other Fee # ice Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 00 Amp 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY T TAL �
Sign/Outline Ltg. Xfmr. � !�
Alarm/Remote Conhol
Swimming Pool
I hereb certi that I ins fed the electr' al installafion dexribed herein on the dafes staied
I�rrigation Boom� — ` - — Rough-In �' �Z � � �.
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requesf void 18 monfhs from validafion daTe printed in fhis box.
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I IIII II II) I) II� (I III II I�I I� I) II III II III I(III ���4l
�K � 4 9 8 9 5 9 6* LEASE PRINT OR TYPE �5��
Request Date Rough-in inspection required? Yes ❑ No Inspection Other Than RougMn: ❑ Ready Now Will Call
D� .�� � �You must call the inspector when ready) Date Ready:
I, icensed confractor ❑ owner hereby request inspection of the above elechical work at:
Job Address (Sheet x, or Route No.� City , Zip Code
1'-� � �iH�i2 c�T �1 �o/� �" � i'L.t ��,e.
Secfion No. Township Name or No. Range No. Fire No. Coun .
��hh � � �
OccuocA�A Phone No.
Power Supplier Address
��
Elecfrical Conha r 1C�om n Name Conkador �icense No. Master Lic. No.
�ITIES�F�EC7bIC, INC. CA00381
310G-^c2bTii oT. W. �GThI. Iv7N 5�024
Mailing Address �Conhacfor or Owner Performin�' a�a�
w �
Authorized Sign re �Conhacf or Owner Pe m Insfallation) ' Phone No.
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&OOOOIA-11 8/96 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY