P - 84499REQUEST FOR ELECTRICAL INSPECTION ��
`�F `t' O-- 2 2 6 Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
�` Phone (612) 642-0800
\ Home Du�lex Aot. Blda. Other: New Addn
Commercial Indusfrial Farm Remod
Air Cvnd. tg. Equip. Water Htr. Load Mgmt. Other:
Dryer an Elec. Heat Temp. Service
"X" above the work cover 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 Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generotor INSPECTOR'S USE ONLY TOTAL
Sign/Oudine Ltg. Xfmr. �
Alorm/Remote Confrol
Swimming Pool
I hereb certi tha'7 I ins the elechi I insfallafion described herein on the dates slafed
Irrigation Boom Roo9h� �
Special Inspection �J
Investigative Fee F���� t---_._____.-- �-;az3C
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OPFICE USE ONLY is request void 18 months from validation date prinfed in this box.
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�K � 4 4 8 2 2 6 1* PLEASE PRINT OR TYPE
RequesT Date Rou h-in ins tion r uired2 es
3^�� �� g pec eq ❑ No Inspection Other Than RougMn: ❑ Ready Now Will Call
(You must call the inspecfor when ready) Dafe Ready:
I, censed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Addreu (Sheet, Box, or Roule No.� City ` Zip Code
�/LL � L �
Secfion No. Towns io Name or No. R e No. Fire No. Coun _
a %��
Phone No.
Power Suoolier n I Address
Elechical ConkaclocJGompqny.plomeL�, �• CA�' Conhactor License No.
GII IES C{.CKiTRtG
810G-225T'�i ST. W.. FGTN., MN 55024
Mailing Addreu (Contracfor or Ownp� r Perform� i�
�• /J �` •
or Owner Per}qd�mhg Inslallafion) ��/1_ � A I P
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STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY