P - 8330567��706 �
Home � � Duplex
Commercial Industrial
above the work
REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone(612)642-0800 ,
Farm Remoc
Water Htr. Load Mgmt. Other:
Elec. Heat Temp. Service
this request. Enter remarks in this space ond on the back of the white copy
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Calculate Inspection Fee - This Inspection Request will no► be accepfed withoui the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stal! 0 to 00 Amp 0 to 100 Amps
Sfreet Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
Sign/Outline Ltg. Xfmr.
Alarm/Remote Conhol
Swimming Pool _
I here certi that I ins the eleclrical insrollafion described herein on the t�
Irrigation Boom R M�
Special Inspectio � ✓ r V— 2 —�
Final tQ.� /_
Investigative Fee eC 1�!
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requesf void 18 monfhs from validation date prinfed in fhis box.
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* 0 6 7 8 7 0 6 3� 7�5�
PLEASE PRINT OR TYPE
ReqLest �°fe � Ro h-in ins on r uired$ es
f rl ug pecti eq ❑ No Inspection O�he� Than RougMr: ❑ Ready Now ill Call
� �� �`fou must call the inspector when ready� Date Ready:
1, licensed contractor ❑ owner hereby request inspection of the above elechical work ar
Job Address (Sfreet, Bo or oufe No.) City /� Zip Code
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Section No. Township Name or No. Range No. Fire No. Cou
�. " � ' Y�+I I Plwne No.
Power
Eleckical Conhacror �Company Name) Contracror license No.
CITIES �! !?��: i�"C, �NC. ctiac� t
310G-��Ti-i �T. W., r'i TN.. W7N 550 4
Mailing Address �Contmctor or Owner Performirg Instd�QfbnKjB j � ��
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Authorized Signature ( acror or r erFormmg ' n)
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&00001 A-11 8/96 �p� gpppD COPY - SEE INSTRUCTIONS ON BACK OF YE