P - 82651RE(�UEST FOR ELECTRICAL INSPECTION --
���� O� Minnesota State Board of Electricity W_
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800 `'�'
Home Duplex Apt. Bldg. Other. New Addn
C mercial Industrial Farm Remod Re air
ir Cond. tg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
Calculate Inspection Fee - This Inspection Request will noi be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall to 00 Amps 0 to 100 Amps
Sheet Ltg./Traffic $ig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTBAL � s�
Sign/Outline Ltg. Xfmr.
!�
Alarm/Remote Control
Swimming Pool �—/� �j
I hereb certi fhat I ins ected the el ical installation described hereln on th tes st
Irrigation Boom Rough-In Dafe
Special Inspec �r .� i - z - �'6
Final D fe
Investigative Fee � 2 �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITH N 18 MONTHS.
OFFlCE USE ONLY This requesf void 18 monfhs from validafion date printed in fhis box.
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* O 4 O O 9 O 5�-; � PLEASE PRINT OR TYPE ���
Request Date q/ Rough-in inspection required2 es ❑ No Inspection Ofher Than Rough-In: ❑ Ready Now Will Call
I� `� '� ! 40 (You musf call the inspecfor when ready� Date Ready:
I, 0 licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sheet, Box, or Route No.� City Zip Code
ID ��`��srf�v�o�v u��y �,eed�ey
Secfion No. Township Name or No. Range No. Fire No. County ��0��
Occupanf Phone No.
�o��� �
Power Supplier � c � Address
J
Eleclrical Conhacfor �Company Name) w� Conhactor License No. Master Lic. No. �Plant EI�
� ��, �r�wMw„
'rr_ �'►7fi.. Mi YOi�
Mailing Addresd�o'r'C'Iwner PerFormir�
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Aufhorized SignaN r Installofi � 8 5� p
B-0OOOlA-11 8/96 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF VELLOW COPY