P - 83148-� r REQUEST FOR ELECTRICAL INSPECTION
�� tl�'9 s 212 Minnesota State Board of Electricity
-� °+ 1821 University Ave., Rm. S-128, St. Paul, MN 55104 =
Phone(612)642-0800
Home Duplex Apt. Bldg. Other: New ddn
Commercial Industrial Farm Remod Re air
Air Cond. Htg. Equip. WaTer HFr. Load Mgmt. Other:
Dryer Range Elec. Heqt Temp. Service
"X" above the work covered by this request. Enier remarks in this space and on fhe back of ihe white copy only.
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Calculate Inspection Fee - This fnspection Request wi!! not be accepted without the correci fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps � 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR°s use d T L
Sign/Outline Ltg. Xfmr. � ��� 3 �� • �
Alarm/Remote Control
Swimming Pool
I here certi IhW 1 ins ihe elechical installalion described herein on ihe dates sfaled
Irrigation Boom Ro„9M„
Speciallnspection � � ��
Final �/ i1
Investigative Fee C� ��
THIS INSTALLATION MAY BE ORDER�D DISt�NdECTED IF NOT COMPLETED WITHIN 18 MONTHS.
� OFFICE I�E ONLY This request wid 18 months from validaficn date prinled in this box.
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INII�IIIHIIIIIIII INIIHIIIIIIH�IIIIII ��o � �� l �� 7
* O S O 4 2 L Z?:� PLEASE PRINT OR TYPE
Requesf Dafe Rou h-in ins on r ved� ❑ Yes
g pacli eq�i �.No Inspeclion Other Than RougMn: ❑ Ready Now�Will Call
�/�'� (You musf call the inspecbr when ready) Date Ready:
I, � licensed conhactor ❑ owner hereby request inspection of the above electrical work at:
Job Addreu (Sheef, Box, or Route No.) Ciy Zip Code
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Seclion No. Township Name w No. Range No. Fire No. � Couny .
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Occupant Phone No.
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Power Supplier
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Electrical Contracror (Company
Mailing AddrE4s (Conhaclor or Owner
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Masfer Lic. No.
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1 8/96 STATE BOAR COPY - SEE INSTAUCTIONS ON BACK OF YELLOW COPY