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REQIJ�ST FOiFf ELECTRICAL INSPECTION
Minnesota State Board of Electricity�
1821 University Ave., Rm. S-128, St. Paul, MN 55104 �
Phone (612) 642-0800 �
Apt. Bldg. Other:� New Addn
Farm � Remod Re air
Water Htr. Load Mgmt. Other:
Elec. Heat Temp. Service
request. Enier remarks in this space and on the back of the white copy only.
Calculate Inspection Fee - This Inspection Request will not be accepted wifhout the correct fee:
Other Fee # Service Entrance Size fee # Circuits/Feeders
Mobile Home Park Stall 0 to 200 Am $'� 0 ro 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Ar
Transformer/Generator INSPECTOR'S USE ONLY TOT�
Sign/Outline Ltg. Xfmr. ^— ��l Hb'�'-=� �
Alarm/Remote Control
Swimming Pool
I hereb certi ihat I ins the eleclrical ' stallafion described herein on the dat�
Irrigation Boom Rou Mn
Fee
��
9 ,�d
Speciallnspect ^'�
F�� _ �� 2/�' -C�
investigative Fee �Q�i-�-�'—
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFPICE USE ONLY This request void �monlhs From validation date printed in fhis box.
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* 0 8 0 2 3 5 0 9* �/SU
PLEASE PRINT OR TYPE
Request Date Rou h-in ins fion re uired? Yes
g pec q ❑ No Inspeclion O�er Than RougMn: ❑ Ready Now Will Call
f�, ��� (You must call the inspeclor when dy) Date Ready:
I, ❑ licensed contractor wner hereby request inspection of the above elecfrical work at:
Job Address (Sheet, Box, w Route No.) Ciy Zip Code
J�,� %�s! � t o� %��' �ir ��r S�'Y'�-/
Secfion No. Township Name w No. . Range No. Fire No. County
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Occupant � � /
/7 h,t /
Power Supplier
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Elechical Confracfor �Company NameJ�s
dreu �Contracfor or Owner Pe
��y� �,��oA
Signalure �Conhaclor o� Ow�
V
e No.
y��,S"7Y-/%�i
1� .n� c,!
r� +1/� �•� s'�y� �
� � � 7L ��Yr/,
STATE BOARD COPY - SEE INSTRUCiIONS ON BACK OF YELLOW COPY