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REQUEST FOR ELECTRICAL INSPECTION _-
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone(612)642-0800 "�'
Apt. Bldg. Other: New Addn
il Farm Remod Re air
Water Hfr. Load Mgmt. Other:
Elec. Heat Temp. Service
y this request. Enter remarks in this space and on the back of the white copy only.
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # Service Entrance Siz Fee # Circuits/Feeders Fee
Mobile Home Park Stall ro 0 Amps 0 to 100 Amps
Sheet Ltg./Tra$ic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOT/�L.�'
Alarm/Remote Confrol �� S L'
Swimming Pool
I here certi that I in the electrical installation described herein on Ihe dates sFOfed
Irrigafi4n Boom RoogMn - ,rz�
Special Inspectio
Firwl � � �
Imestigative Fee
THIS INSTALLATION MAY BE ORDERED DISCONN TED IF NOT COMPLETED WITHIN 18 MON
OFFM:E I�E OHIY This request void 18 months 6om validation date printed in this box.
Ip' • 7�-% ' �
(IIIIIIIIIIIIIIIIIIIII IIIIIIIIIIIII�I� . cJ�O/�
* 0 5 6 6 9 9�G 4* PLEASE PRINT OR TYPE
R�1�� ^� Rough-in inspection required? Yes ❑ No Inspeclion OTher Than RougMn: ❑ Ready Ni
�'� �`(ou must rnll fhe inspeclor when ready) Dote Ready:
I, licensed contractor ❑ owner hereby request inspection of the above elecfrical work at:
Job Address (Sheef, Box, w .) Ci� Zip Code
� �,
Secfion No. Township Name or No. Range No. Fire No. County
�.c panf , w _ Phone No. -
Elechical Conhacror
Mailing Addreu (C�
rry Name) Conkactor license No.
qn���W�NF� ^ ^^�A400381
q� nr.. . I��''+5Q24
or Owner Per(orming Installatio . ,�'�.�10
!' �- - � - � �
Master lic. No.
I
11 8/96 y�p� BpppD COPY - SEE INSTRUC710NS ON BACK OF YELLOW COPY
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