P - 83364REQUEST FOR ELECTRICAL INSPECTION
��(� � � � Q � � _ Minnesota State Board of Electricity
.� C�� 1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800 `��'
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enier remarks in this space ond on the back of the white copy only.
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Calculate Inspection Fee - This Inspection Requesf will not be accepfed withou► ihe 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/Generator INSPECTOR'S USE ONLY TOTAL
Sign/Outline Ltg. Xfmr. %��
Alarm/Remote Conhol
Swimming Pool
I hereb certi Ihat I ins ihe electrical installafion deuribed herein on the daies stated
Irripation Boom R�„��,a„ oar�
� � Final � Da f � Z�i{ �
Investigative �� - `-'
THIS INSTALLATION MAY BE ORDERED DISCO IF NOT COMPLETED WITHIN 18 MONTHS.
OFFlCE USE ONLY This request void 18 months from validafion date printed in this box.
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* 0 6 9 3 3 8 6 5* 7�S
PLEASE PRINT OR TYPE
Request Date Rouglfin inspeclion required$ ❑ Yes No Inspecfion Other Than Rough-In: eady Now ❑ Will Call
�0 �(r�8' �You must call ihe inspecror when ready) Date Ready: Q 3�� 9�
I, �licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Addreu (Sheet, Box, or Roufe No.� Ciiy Zip Code
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Section No. Township Name or No. Ra�ge No. Fire No. County
Occupant
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Elechical Conhactor (Company Name�
f�TS Ec�c�r,e��
Mailing Address (Conhactor w Owner
or
I �_
iing Installation)
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Phone No. p
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:onM1nctor License No. Masfer Lic. No. (Plant Elect.
C�to � y89
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Phone No.
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COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY