P - 83279" REQUEST FOR ELECTRICAL INSPECTI'�N
�� G` ��� C� /I � Minnesota State Board of Electriciry �
0 � y' 1821 University Ave., Rm. S-128, St. Paul, MN 55104
�:
Phone(612)642-0800
Home Duplex Apt. Bldg. Other: New
Commercial Industrial Farm Remod
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 white
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Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Sfreet Ltg./Traffic Sig. Above 200 Am s Above 100 A
Transformer/Generator INSPECTOR'S USE ONLY TOTi
Sign/Oudine Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
i
Irriaation Boom Ll L� if i: �
�ra
copy only.
Fee
.oe
•$�a
�-- �o
Firal
Investigative Fee
THIS iNSTALLATION_MAY BE ORDERED DISCONNECTED IF NOT COMPLETED W! HIN 18 MONTHS.
OFFICE USE ONLY This requesf void 18 months from volidation dote printed in this box.
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* 0 6 8 2 3 9 4 7* ���0�
Raquesr vare Rough-in inspection required$ ❑ Yes
/Q ,�/ ` C� �' (`/ou must coll the inspector when reody)
I, �] licensed contractor ❑ owner hereby request inspectic
1ob Address �Sheet, Box, or Roule No.�
Section No. Township Name or No.
�a T! qa.n g
Power Supplier
Electriml Contracror (Company Name)
Address (Cbnhactor or Ov,mer
STATE
PLEASE PRINT OR TYPE
� No Inspection Ofher Than Rough-In: .Ready Now � WII Call
Date Ready:%D �" 96
e above elecfrical work at:
. . �-.; � Zip Code
�a,a��y �-�-y
No. Couny
,�NO +� �
Phone No.
� /St-��'7�`�9'<3'�
macror License No. I Master Lic. No.
A�Fz
hone No.
265� ` �a-�
NS ON BACK OF YELLOW COPY