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Home Duplex Apt.
Commercial Industrial Farrr
REGIUEST FOR ELECTRICAL INSPECTION �,����,
Minnesota State Board of Electricity ��,,��';
1821 University Ave., Rm. S-128, St. Paul, MN 55104 �"�°'�j,� -�'
Phone (612) 642-0800
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Other: New Addn
Remod Repair
ir Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
er Ran e Elec. Heat Temp. Service
"k' above the work covered by this request. Enter remarks in this space and on
copy
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Olher Fee # Service Enhance Size 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'SUSEONLY TOT�
Sign/Outline Ltg. Xfmr. �—
Alarm/Remote Control
$wimming Pool
I hereb certi thaf I ins eded ihe eledrical installation described herein on ihe dates stated
Irrigdtion Boom Rough-In �—� Da'�/ _q�
Special Insped' � �
Final D e
Investigative F . — Z.
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
I�`�- 3 4 7� �FFICE USE ONLY This request void 18 monih5 from validation date prinfed in this box.
.
S�� ��Z
PLEASE PRINT OR TYPE �•��
Requesf Date Rough-in inspedion required2 Yes � No Inspedion Other Than Rough-In: � Ready Now Will Call
� � �� (You must call the inspedor when ready) Date Ready:
I� licensed conTractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Streef, Box, or Route No.) City � Zip Code
1 J
Section No. Town:hip Name or No. Range No. Fire Na. Couniy ^
nt
Address
Eledrical Contractor �Company l��ES ELECTRIC� �, �ticense No.
a�oarzsn� sr. �. �nv.. N s6ou
Mailing Address (Contrador or Owr�r Performing InsjAllotion)
F� r � .
Authorized
EB-OOOOlA-10 6/95
Phone No.
Master Lic. No. (Plant Eled. Only)
Owner PetfdSming Installatiqr��� ��' (� �� Phone No.
V 1
STATE BOARD COPY - SEE I NSTRUCTIONS ON BACK OF YELLOW COPY