P - 82757REQUEST FOR ELECTRICAL INSPECTION = �
C� r� � 4 p� Minnesota State Board of Electricity
L-� �C. O 1821 University Ave., Rm. S-128, St. Paul, MN 55104
� Phone (612) 642-0800
�( Home - Duplex Apt. Bldg. Other � M � New Addn
Commercial Indostrial Farm v (/ x Remod Re ir
Air Cond. 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 and on the back of the whiie copy only.
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Calculate Inspection Fee - This Inspection Request will not be accepted without fhe correct fee:
Other Fee # Service Entrance Size Fee Circuits/Feeders
Mobile Home Park Stall 0 to 200 Amps ro 100 Amps
Sheet Ltg./Traffic Sig. Above 200 Am s Above 100 Ar
Transformer/Generaror iN ECTOR•_ s�sE ONLY L��` TOT,
Sign/Oudine Ltg. Xfmr. ��°C �-N^' �`/��`�C �
Alarm/Remote Control ,�'J�Jf�? n a� /
c...:__:.._ o..,,� — �3 W %
Fee
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I here-b'v 'certifv that I insoec�ed the ele�2al insmllation described herein on the dcrtes swred
Investigative Fee � - - /"'Ll"^G
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE 1lSE ONLY This request void 1�s 6om validafion dafe printed in this box.
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* 0 5 3 2 4 8 7 6�Ic PLEASE PRINT OR TYPE
� Request Date � � iRspeclion req�ired$ �Ves ❑ No Inspecfion Olher ihan RougMn: dy �
❑ Rea Now Will Call
� 3 J/�j � q e� (7ou musf mll the inspeclor when ready) Dafe Ready:
I, ❑ licensed confractor � owner hereby request inspecfion of the above electrical work at:
Job Address (Sheet, Bmc, or Rou�e No.) Ciy Zip Code � .
5�t1 PovAr S�E�; G�(t F<<t� �� S�43a
Seclion No. Township Name w No. Range No. fire No. Couny
3 o a'� �4�� k�a
Occ�panf Phane No.
-Sco7� �r4 .`n5*�/2 7Q0 —�'1So2S
Power Supplier Address �
O�1S(� ✓�'�:nNeapol�s (/�(o��� �iJ�SioN
'�ddreu (Conhaclor w Owner Performing InsMllation)
5 �.ti.�
� 5� (Co�� ing Instollation)
2�
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hl l 8/96 S7ATE gpppD COPY - SEE INS7RUCT10NS ON BACK OP
Phone No.
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