P - 79882REQUEST FOR ELECTRICAL {NSPECTION
� Q O�����% � Minnesota State Board of Electricity
v � 1821 University Ave., Rm. S-128, St. Pauf, MN 55104
�
Phone (612) 642-0800
Home Duplex Apt. Bldg. Other: New Addn
Commercial {ndustrial Farm Remod Re air
Air Cond. Hfg. 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.
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Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # e' ance Si e Fee # Circuits/Feeders Fee
Mobile Home Park Stall t 200 ps 0 to 100 Amps
Street Ltg./Traffic Sig. Abov�-2@0 l�m s Above 100 Amps
Transformer/Generator INSPECTOWS USE ONLY TO �
Sign/Outline Ltg. Xfmr. A� Q•] � <
Alarm/Remote Control �< <� �> > S,
Swimming Pool ��' / � G
I hereb certi ihW I ins � the electriwl installafion described he n e slated
Irrigation Boom RougMn • �
Special Inspection ��"�
Investigative Fee F���� �j d %�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WRHfN 18 MONTHS.
, OFFICE USE ONLY This request void 18 monihs irom validation date printed in this box.
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* 0 8 0 2 3 3 7 6* 2 9�� 1(���
PLEASE PRINT OR TYPE �`�
Requesf Date Rou h-in ins on r uiredR ❑ Yes
g pecfi eq ❑ No Inspection Other Than Rough-In: ❑ Ready Now � Will Call
. �`/ou musl call IFie inspector when ready) Date Ready:
I, ❑ licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Rovte No.) Ciy Zip Code
l 4s l�-�Tn�n-�� � L- ss4�3 z
Seclion No. Township Name or No. Range No. Fire No. Cou�ty
Occupanf � �� � Phone No.
�iou�(s"i?� '�63-so2- 30�0
Power Supplier Address
�1CCP�L
Electrirnl Conhacbr (Company Name) Coniracror License No. /vlaster Lic. No. �Plant Ekct. Onl�
Mailing Address (Conhacfor or Owner Pedorming Insfollalion)
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STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY