P - 84337RE(IUEST FOR ELECTRICAL INSPECTION
O-� 17 Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
� Phone (612) 642-0800
Home Duplex Apt. Bldg. Other: New
Commercial Industrial Farm Remod
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
ryer /1�" Rang / Elec. Heat Temp. Service
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"X" above the work covered by ihis 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 # Service Entrance Size Fee # Circuits/Feeders
Mobile Home Park Stall 0 to 00 Am % 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Amps Above 100 Am
Transformer/Generator INSPECTOR'S USE ONLY TOT}A
Sign/Outline Ltg. Xfmr.
Alarm/Remote Control
S ' P I
Fee
wimming o0
I hereb certi that I ins ected the electrical installation described herein on the dates stated
Irrigation Boo .Roogtao � , re � �'I
Special lnspection ��—
� Final _� _ . ��-- � �.,1 �'7
Investigative Fee �
THIS INSTALLATION MAY BE ORDERED DISCON CTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validation dafe printed in fhis box.
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* O 4 O O 9 L 7 L* PLEASE PRINT OR TYPE
Re uesf Date Rough-in inspection required? Yes ❑ No Inspection Ofher Than Rough-In: ❑ Ready Now Will Call
q�q � (You musf call the inspecror whe ready� Dafe Ready:
I, licensed contractor ❑ owner hereby request inspection of the above electrical work at:
1ob Address (Streef, Box, or Roufe No.) City � Zip Code '
�
Section No. Township Name or No. Range No. Fire No. Coypry
1 lr� �
trical ConMactor �Company Na� a
ling Address (Conhactor or Owner P_ e� r�g
�
iorized Signafure (Conkacfor o ner erfon
STATE BOARD
IPhone No.
Address
��. Conhador License No. Master Lic. No. �Plant Elecf. Only)
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�����q�--� — -i �� ty -.R Phone No.