P - 82908REGIUEST FOR ELECTRICAL INSPECTION
6��� 1 �� Minnesota State Board of Electricity `3
t .L 1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone(612)642-0800
Home Duplex Apt. Bldg. Other: New Addn
Commercial Indusirial Farm Remod Re air
Air Co Htg. 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 ►he white copy only.
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct 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 Amps Above 1 UO Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
Sign/Outline Ltg. Xfmr. ���s �
Alarm/Remote Conhol
Swimming Pool
I hereb certi thaf I ins the electrical installafion described herein on the dates stakd
(rrigation Boom Rough-In Dare
Speciallnspecti i`
Final Date
Investigative Fee � �— Z
THIS IN�STALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
- OFFICE USE ONLY This request void 18 monihs from validation date prinfed in ihis box.
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PLEASE PRINT OR TYPE
Request Da1e Rough-in inspecfion required$ ❑ Yes No Inspecfion Other Than RougMn: Ready Now � Will Call
s3..9� (You musf call the inspeclor when ready) Date Ready: �/O �
I, � licensed confractor ❑ owner hereby request inspection of the above elecfrical work at:
lob Addreu �Sheet, Box, or Route No.� Cily Zip Code
�f 7 f/u o ST �►l� �"r� o/ley
Secfion No. Township Name or No. Range No. Fire No. County
KQ �
Occuponf Phone No.
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Power Supplier Addreu
Electrical Contractor �Company Name) Conhacror License No. Master lic. No. (Planf Eleci. Only)
T..s' �t,ECr,e� � C�-o iyg
Mailirg Address (Contractor or Owner PerForming InsMllafion�
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Authorized Signature �Conhacfor or Owner Performing Insfallafion) Phone No.
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E OlA-11 8/96 • S TE B D COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY