P - 8396944�-9�� eee,
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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
Home Duplex Apt. Bldg. Other: New
, Commercial Industrial Farm Remod
� Cond. Htg. Eq ' Water Hic Load Mgmt Other:
Dryer ange Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on ihe back of the white copy
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Calculafe Inspection Fee - This Inspeciion Request will not be accepied withoui the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 00 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL r
Sign/Outline Ltg. Xfmr. �' �7
Alarm/Remote Confrol
Swimming Pool
I hereb certi that 1 ins ted fhe electrical insfallafion described herein on the dates sfafed
Irrigation Boom Ro� Mn � D
Special Inspectio 9 h� � � � �
Investigative Fee F�°°I � oa z_
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requesf void 18 months from validation date printed in this box.
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�K � 4 9 8 9 7�G 9* PLEASE PRINT OR TYPE � 5��
Req est Date Rough-in inspecfion required? Yes ❑ No Inspecfion Olher Than RougMn: ❑ Ready Now Will Call
C- � a�. (You must call the inspecfor when reody) Date Ready:
�, icensed contractor ❑ owner hereby request inspection of ihe above electrical work at:
Job Address (Skeet Box, or Roufe No.) � Ciy Zip Code
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Section No. Township Name or No. Range No. Fire No. County
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Occuoauf% Phone No.
Power $upplier x � � Address
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Elechical Conhacror �Compal y �(�`, INC. CA Conhaclor license No.
CITIc� F�� �N 55024
G-225Tii 3T. W., FGTN.�
Mailing Address (Coniracbr or Owne� Performin nsta afion)
Owner Perf�ining InsfallaKon)
I EB-OOOOlA-11
Moster Lic. No.
No.