P - 84573REGIUEST FOR ELECTRICAL INSPECTION
'-F �F �=- 2 3 7 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 Addn
Commercial Indushial Farm Remod Re air
ir Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Range , Elec. Heat Temp. Service
"X" above the work covere y this request. Enter remarks in this space and on the back of the whiie copy only.
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Calculaie Inspection Fee - This Inspeciion Request will not be accepted without the correct fee:
Other Fee # Service Entrance Si Fee # Circuits/feeders Fee
Mobile Home Park Stall to 00 Amps 0 to 100 Amps
Street Ltg./Traific Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPEC70R�S USE ONLY TO��
$ign/Oudine Lfg. Xfmr.
Alarm/Remote Confrol /%
$wimming Pool �
I hereb certi that I ins ted the elechicol installation described herein on fhe dafes stated
Irrigation Boom RougMn / pa�r�7 �7
.S�CCIO� �f1Sp2C�l _� .� . '�-- � / � �` -��
Final �
Investigative Fee �"`----�� — ��
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 monihs from validation date prinfed in ihis box.
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* 0 4 4 8 2 3 7 8* p PRINT OR TYPE
Requesf Date Rou h-in ins tion re uired? es
� pec q ❑ No Inspection Other Than Rouglrin: ❑ Ready Now Will Call
��- � a!, �� (You must call ihe inspector when ready) Date Ready:
I, icensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sheef, or RouM No.) City � Zip Code
1$ y� � ►2 � b c.�.
Seclion No. Township Name or No. Range No. Fire No. County
� 14 bC�b 7�.�i
� Prnver
Phone No.
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>nhacfor (Company Name) Conhacior License No. Masfer Lic.
CITIES ELECTRIC. INC• �, „*��d
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in9 Insta��ation) 2 5� 2�.�
E BOAHD COPY - SEE INSTRl1CT1�NS nN 1