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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
Other: New
Commercial Industrial Farm
ir Cond. ' Ht . Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above ihe work covered by this request. Enter remarks in this space and on
Remod
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copy only.
Calculaie Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 0 Amp 0 to 100 Amps
Street Ltg./Traffic Sig. Abo e 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL 5 O
Sign/Oudine Ltg. Xfmr. 5 ^—
Alarm/Remote Control
Swimming Pool
I hereb certi that I ins ihe elec ' al installation describad herein on the dates stafed
Irrigation Boom RougMn �+� Z
Special lnspecti ' J
Final . �'L _'�_____�--�_. � �af� ' �--'
Imestigative fee �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 1 M NTHS.
OFFICE USE ONLY This requesf void 18 monfhs from validaficn date printed in fhis box.
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* 0 5 2 2 9 L 2 5� PLEASE PRINT OR TYPE !' �SU
R uesi Date Rough-in inspecfio� required? Yes ❑ No �nspectian Other Thon Rough-In: ❑ Ready Now Will Call
1� O� � (You musf call the inspector when ready) Date Ready:
f,'�licensed contracror ❑ owner hereby request inspection of the above electrical work at:
Job Address �Sheef, Box, or Roufe No.) � Ci � Zip Code
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Fire No.
Phone No.
Elechical Contractor (Company Name) Contractor License No.
CITIES FLECTRIC, INC. CA00381
N 55024
Mailing Address (Conhacror or Owner PerForming Insfallafion) �'3.�10
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Authorized Signafure (Conhacfor or Ow rming o 2 5�(,�n
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EB-00001 A-1 1 8/96 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF 1
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