P - 82520REQUEST FOR ELECTRICAL INSPECTION �
8✓ (� Minnesota State Board of Electricity �
:J �� 2 3 5� 1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-OS 0 `'�`
Home Duplex Apt. Bldg. Other:/ � r�� New Addn
Commercial Industrial Farm !�(� � Remod Re air
Air Cond. Htg. 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 Inspec�ion Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # Se ' trance S' Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 200 mps 0 to 100 Amps -/
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOT/9,J�. . cQ
Sign/Oudine Ltg. Xfmr. � �
Alarm/Remote Control
Swimming Pool �._B.�/(��f�-2 �O Gt
I hereb certi thaf I ins e elecfrical insfallatio escri erein on e dates sta
Irrigation Ro� h-i�
Special Ins 9 �� w �
Firwl D
Investigative Fee '2�/ '
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months hom validation daTe prinled in IFiis box.
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�`'' PLEASE PRINT OR TYPE
Request Dat Rou h-in ins eclion r uired$ Yes A�t''
g p eq � ❑ No Inspection Other Than RougMn: ❑ Ready Now�p vvill Call
�� 7 (You musf call the inspector when ready� Dote Ready: ��
I, licensed conhactor �owner hereby request inspection of the above electrical work at:
Job Addreu �Sheet, Box, w oute . Ciy / Zip Code
�-� � ! /' l � .�.� �
on o. Township Name a No. Range No. Fire No. Co ny
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Occupanf/�� /• / /� . . f PhoneNo. � - - _
Eleclrical Conhacror (Company Name
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Mailing Address (Conhactor or Owner
�86 :S'�s
� /l�r�� /�./`vYa/Li,
Confracfor License No. Masfer Lic. No.
�fion Phone No.
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- SEE INSTRUCTIONS ON BACK OF YELLOW COPY