P - 83397REQUEST FOR ELECTRICAL INSPECTION =� s
5.>� ?� 5 4 0 Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
` Phone (612) 642-0
me Duplex Apt. Bldg. Other: C /� New Addn
Commercial Industrial Farm � C�/�' Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heaf Temp. Service
"X" above the work covered by this request. Enler remarks in this space and on the back of the white copy only.
Calculaie Inspeclion Fee - This Inspection Request will nol be accepted without the correct fee:
Other Fee # Service Entrance Size f-ee # Circuits/Feeders F
Mobile Home Park Stall 0 ro 200 Amps 0 to 100 Amps
Sfreef Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR•S use oN�Y TOTAL ��`S�
Sign/Oudine Ltg. Xfmr.
Alarm/Remote Confrol
Swimming Pool
I here certi that I i �he elechiwl iostallotion deacribed herein on �he dores slalad
Irrigation Boom RagMn Dare
$pecial Inspecti ,
Final ] �
Investigative Fee '—TE��
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMP�ETED WITHIN 18 MONTHS.
� OFFlCE USE ONI.Y This requestvoid 18 months kom validation dale prinfed in this box.
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* 0 5 3 G� 5 4 � 2�Ic PLEASE PRINT OR TYPE
Request DWe �`�� Rough-in inspection required$ Yes ❑ No InspecFion 01her Than Roughan: ❑ Ready Now �II Coll
.� � �You must call the inspecior when ready� Date Ready:
I, ❑ licensed conhactor �owner hereby request inspecfion of the above electrical work at:
Job Address (Street, Box, w Rouie No.) Ciy Zip Code
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Section No. Trnmship Na w No. Range No. Fire No. Cou
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-t�l�vi� L . S.c�7zl� � 7� ^82S" �
Power Supplier Address -
/� � S' „ ,�/l��LS iL/Ory7`Gr O/ d .
Eleclrical ConhacTor y Name) Conhactor License No. Master Lic. No: (Mant Elect. Onl�
C.��.�/
Mailing Address (Contraclor a rming InsWllalion)
Authorize��i alure (Conhaclor or Owner Pe rming Inslallotion) � . Phone No.
� ' 6 �����..�'3
E&00001 A-11 8/96 �ATE BOARD COPY - SEE INSTRUC710NS ON BACK OF YELLOW COPY