P - 80355REQUEST FOR ELECTRICAL WSPECTION ��,
Q(� � e� Q Z � Minnesota State Board of Electricity
��� V 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 Re air
Air Cond. Htg. Equip. Water Htr. Lopd 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 onfy.
Calculate lnspection fee - This Inspection Reques� wid not be accepied withouf 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 Amps Above 100 Amps
Transformer/Generator INSPECTOH'S USE ONLY TOTAL.�� �
Sign/Outline Ltg. Xfmr. 0i
Qlarm/Remote Control
Swimming Pool
I hereb certi that I ins fed the elechical installafion described herein on the dotes sfafed
Irrigation Boom RougMl� Date
Special Inspectio
Investigative Fee ,. final Da�, � ` d�
/
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 mon�hs from validafion date prinred in this box.
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PLEASE PRINT OR TYPE
Request / /` Rou9h-in inspection required2 ❑ Yes No Inspecfion Ofher Than Rough-In: ❑ Ready Now Will Call
r' p�/ � V� (You must call the inspector when ready) Date Ready;
I, ❑ licensed contractor f�owner hereby request inspection of the above electrical work at:
Job Address (Sheet, Box, or Route No.) Ciiy \ Zip Code
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Section No. Township Nome or � Range No. Fire No. /� _ �
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Occupan� Phone No.
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ny Nam �
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or Owner PerFormi�
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icror or Owner Per6
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ConhacFor License No. Master Lic. No.
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