P - 82320REQUEST FOR ELECTRICAL INSPECTION ��
4�� r� � Minnesota State Board of Electricity �♦ �
I C..) 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993
(651) 642-0800 www.electricity.state.mn.us =���
plex I I Apt. Bldg
New
�4ir Conditioner 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
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Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Installations Fee # Service Entrance Size Fee # Circuifs / 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 INSPECTOR'S USE ONLY TOTAL _
Sign / Outline Ltg. Xfmr.
Alarm/Remote Control
$wimming Pool
._ I
Repair
' �_. ��-_—�
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instatlation described herein on the dt
Dafe
Speciallnspecfio?5"`� ti
Final Li .�i�
Investigative Fee — ����
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requesf void 1 S months from validation dafe printed in fhis box.
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PLEASE PRINT OR TYPE
Request Date Rough-in'inspection required? ❑ Yes �1Jo Inspection Other Than Rough-In: ❑ Ready Now �/ill Call
� u�� You must call the inspecfor when ready Date Ready:
I,�jlicensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
Job Address �Sheet, Box, or Route No.) Ciry � ��. p)� Zip Code
Section No. Township Name or No.
Occupant
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Elechical Conhacror j Com
BLAINE
Mailing Address (ConMac
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A/C & Eltr;T. !i:::.
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No. Fire No. Couny
II
Phone No. �
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5
Conhactor License No. Master Lic. �
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EB-00001A-12 5/1 STATE BOARD COPY SEE INSTRUCTIONS ON BACK OF YELLOW COPY