P - 84594REQUEST FOR ELECTRICAL INSPECTION
4�'� = 2 3 8 Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
` Phone(612)642-OS00
Home Duplex Apt. Bidg. Other: ew Addn
Commercial Indusfrial Farm Remod Re ir
Air Co Htg. Equi . Water Hh. Load Mgmt. Other.
Drye /// ang Elec. Heat Tem . Service
"X" above the work covere y this request. Enter remarks in this space and on the back of the white copy only.
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Calculate Inspection Fee - This Inspection Request will not be accepfed withoui the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park $tall 0 to 00 Amps 0 to 100 Amps
Sfreet Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Tra�sformer/Generator INSPECTOR�S usE ON�v TO�L _�.
Sign/Oudine Ltg. Xfmr. •�'
Alarm/Remote Conhol
Swimming Pool
I hereb certi that I ins the elechical installafion described herein on the dafes staled
Irrigation Boom Rough-In [�
Special Inspec' C9 �'L7—l� %
Investigative F Fina1 � D
----L_ '-� 3 — .
_ THIS INSTALLATIONF MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 1 R months from va�idation date printed in this box.
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LEASE PRINT OR TYPE
Request Date Rou h-in ins �on r �ired$ Yes
9 P�� eq ❑ No Inspection 01her Than RougMn: ❑ Ready Now ill Call
(You must call the inspecfor when ready) Date Ready:
I, censed confractor ❑ owner hereby request inspection of the above electrical work at:
.bb Address (Sheef, Box, or Route l�o.) � Ci •
� � � h �.'^ l�- Zip Code
Y �
Section No. ownship Name or No. Range No. Fire No. County
N �
Occu�nt Phone No.
Power Suppli � � - Address
oo�si
Elechical Cont� + � Conhacfor License No. Master
81�7'��J� 'J�� WH ����
Mailing Address ( actor w Perfor mg stallation)
Authorized Sig re(Conhactor or Owner Pe ing Installafio � 06,...e i