P - 83184� RE�QUEST FOR ELECTRICAL INSPECTION =
5 C� C) ``° 9 8 9 Minr�esota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800 "�'
Ho e Duplex Apt. Bldg. Other: New Addn
ommercial Ind ial Farm Remod Re air
Air Cond. tg. Equip. Water Htr. Load Mgmt. Other.
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on the back of the while copy only.
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Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # Service Entrance S" e Fee # Circuifs/Feeders Fee
Mobile Home Park $tall �- to Amps .,, 0 to 100 Amps
Street Ltg./TrafFic Sig. Abov 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTA
Sign/Outline Ltg. Xfmr. , �
Alarm/Remote Conhol
Swimming Pool
I her certi thaf I ins the electrical installaKon described herein on the dates stated
Irrigatian Boom RougMn � Dore
Special Inspect ' 2�
Investigative Fee F�nal ,
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHI 1 MONTHS.
7—_— �- -�-- - --- ---- . _.. .__ . . -- ----
OFFlCE USE ONLY This request void 18 months from validafion date printed in this box.
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* � 5 6 6 9 8 9 �* PLEASE PRINT OR TYPE
Reque 1��� RougMin inspecfion required$ Yes ❑ No lnspecfion Olher Thon RougMn: ❑ Ready Now �II Cal!
oti- �You musf call Ihe inspecror when ready) Dafe Ready:
I, licensed contracror ❑ owner hereby request inspection oF the above elecfrical work at:
Job Address (Street, Box, R No.) Ciy �� � Zip Code
O�
Section No. Township Name w No. Range No. Fire No. Counly�� n
Power Sup lier
Eleclriwl Conhacror (Company
Mailing Address (ConhacMr or
Phone No.
Conhacror
ES ELECTRIC, INC. Ap0381
;-22�T'rl ST. W� �^v TPl. ti 55024
Performing Instgllafion� �.�j3�Q
L (J w ,
lic. No.
vwner rerro►mir� Insfallqhqq' - �. ��.� .. + Phorre No.
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STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY