P - 83247REQUEST FOR ELECTRICAL INSPECTION
5?�)� C�i A m Minnesota State Board of Electriciry
G J G�t 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 Hh. Load Mgmt. Other: � o�
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on the back of 1he whiie copy only.
Calculate Inspecfion Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stoll 0 to 200 Amps 0 ro 100 Amps
Street Lig./TrafFic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR°S USE ONLY TOTAL�/ �
Sign/Oudine Ltg. Xfmr.
Alarm/Remote Conhol �
Swimming Pool
I her ceAi thW I ins the eleclrical installation described herein on the dates stated
Irrigation Boom Rough-In r �r ^ �
Special Inspecti
Firal )
Invesfigafive F -oo (�Z2d�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 ONTHS.
� OFflCE USE ONIY This request void 18 months from validation date printed in this box.
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* � 5 3 2 5 2 4(� * PLEASE PRINT OR TYPE
R��S� /p �jQ Roughin inspecfion required$ Yes ❑ No Inspeclion Other Than RougMn: ❑ Ready Now Will Call
� L v' `(� �You must call the inspector n ready� Date Ready:
I, ❑ licensed contractor j� owner hereby request inspection of the above electrical work at:
Job Address (Sheet, Box, w Rou�e No.� � Ciy Zip Code � �
1 �I � - I�tE � ( 55�32
Secfion No. Township Nome w�� � Rarge No. Fire No. Couny
oc O�
��r�A cn i co � . �P� cs.�� .a ��c�
rica� � (Com ny Name)
ing Address (Conhacror w Owner Performing
3'�1 �It.1.E'.P.t�T
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. � 'D(,L� SS�i�`z
i Installafion) Phone No.
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COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY