P - 82649RE(�UEST FOR ELECTRICAL INSPECTION
�" �'�J � 9 0 3 Minnesota State Board of Electricity
.� 1821 University Ave., Rm. S-128, St. Paul, MN 55104 �:
Phone (612) 642-0800 `�'
Home
"X" above the
Apt. Bldg. Other: New
�I Farm Remod
uip. Water Hh. Load Mgmt. Other:
�� Elec. Heat Temp. Service
by this reques►. Enter remarks in this space and on the back of the white copy
Calculate Inspection Fee - This Inspection Request will not be accepfed without the correct fee:
Other Fee # Service EMrance Size Fee # Circuits/Feeders
Mobile Home Park Stall 0 to 00 Am r 0 to 100 Amps
Street Ltg./Traffic Sig. Ab e 200 Amps Above 100 Amp;
TransFormer/Generator INSPECTOR'S USE ONLY TOTAL
Sign/Outline Ltg. Xfmr. ��
Alarm/Remote Confrol
Fee
50
�
Swimmin Pool
9 I hereb certi thaT I ins ted fhe elecfrical installafion described herein on the �s �ted
Irrigation Boo Rough-In Dafe
Special Inspec' � �'�` ' i� g�
Final - Date_ ; �`
Irnestigative Fee � —� `�z < `� c�'" / 7
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validafion dafe printed in fhis box.
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* 0 4 0 0 9 0 3 1 * �� ����Z Z
PLEASE PRINT OR TYPE
Requesf Dafe Rou h-in ins wn r uired? Yes
— � �� g pect eq ❑ No Inspection Other Than RougMln: ❑ Ready Now Will Call
(You musf call the inspector wh n ready) Date Ready:
I,�,licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sheet, Box, or Roufe No.� � Ci � Zip Code
� � ,
Settion No. Township Name or No. Range No. Fire No. County
Power Supplier '
{
Elecfric C nhacror (Company NameJ
�
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Mailing Address (Conhacfor or Owner P
♦ �
EB-00001 A-11
Phone No.
License No. I Master Lic. No.