P - 81119RE(�UEST FOR ELECTRICAL INSPECTION ��
p��� 16 9� Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104 �;
� Phone (612) 642-OSOOV r �/Y� �
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Home Duplex Apt. Bldg. Other:A .��� �� New Addn
Commercial Industrial Farm !" � Remod Re air
Air Cond. 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 fhe whife copy only.
Calculate lnspecNon fee - This lnspection Request ' be accep 'thout he correcf fee:
Other Fee # Service Ent ance Size # Circuits/F Fee
Mobile Home Park Stall � 0 to 2 s � t•� 0 to 100 Am s: �
Street ltg./Traffic Sig. Above 00 Am s Above 100 Amps
Transformer/Generator iN ��oR's��zo��2,, '� TOTAL��c%1
$ign/Outline Ltg. Xfmr. � S / , V
Alarm/Remote Conirol 2 5 aQ/ /
Swimming Pool � "' � 1� �t �
I hereb certi that I ins the el ' I insMllation described herein on ffie d���., .._._..
Irrigation Boom Ra„y�,.�„ �ore._ -
Special Inspect' -
F� . i . .. � ofe
Investigative Fee .��_
THIS INSTALLATION MAY BE ORDERED DISCONNEC IF ryOT COMPIETED WITHIN S� tINTHS.
OFFICE USE ONLY This request void 18 monfhs from validation date printed in this box.
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PLEASE PRINT OR TYPE
Request Date Ro� h-in ins cfion r uired? ❑ Yes
g pe eq ❑ No Inspecfion O�er Than RougMn: ❑ Ready yow 0 Will Call
1�•- ��� �You must call the inspector when ready). Date Ready:
I, ❑ licensed conhactor (�owner hereby request inspection of the above electrical work at:
Job Address �Sheet, Box, or Route No.) Ci Zi Code
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Section No. 7ownship Nome or No. Ronge No. Fire No. County
`30 ��{ A-� �
Occup ant n Phone No.
lre ICr ���s"� b�� $��o �
Power Sup lier q�� �
I1f S� �ipLs N �; ✓ •
Elechical Contracror (Company Name� Conhaclw License No. Masler Lic. No. (PIaM Elect. Only)
Q��
Mailing Address (Contractor or Owne� Performing Installafion)
Sol.v��-�
Au ' uture o or Owner P ming Installafio j� Plione No.
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E � A-� � 9 STATE BOARD C Y- SEE INSTAUC710NS ON BACK OF YELLOW COPY