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Commercial
Air Cond.
Dryer
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Duplex
Industrial
Hrp. Equi
REQUEST FOR ELECTRICAL INSPECTION �
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104 �'
Phone (612) 642-0800 '�'
Other: New Addn
Farm
Water Htr. Load Mgmt. Other:
Elec. Heat Temp. Service
request. Enter remarks in this space and on
Remod
of the whiie copy only.
Calculate lnspeclion fee - This lnspection Requesi wil! not be accepted withouf Jhe 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 100 Amps
TransEormer/Generator INSPECTOH•S usE oN�v TOTAL 5-p
$ign/Outline Ltg. Xfmr. ��
Alarm/Remote Control
Swimming Pool
I hereb certi thaT I ins the electrical installation described herein on the dates sfated
Irri9ation Boom � RougMn Dare
$peciallnspecti �
Investigative Fee � D �Z�'Z �d
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WI7HIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months (rom validation date prinfed in this box.
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PLEASE PRINT OR TYPE
Request Date Rou h-in ins on r uired?
g pecti eq ❑ Yes No Inspeclion Olher Than Rough-In: Ready Now � Will Call
�� (You musf call the inspecfor when ready� Date Ready: �ZZ�9
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
lob Address (Sfreet, Box, or Rouffi No.) Cily Zip Code
7G SO -�T•�c.kco�n s'T/✓eR Fr 1 c,� �e
Seclion No. Township Name or No. Ranpe No. Fire No. Couny
OccupaM,
j'1i1G��. �ik�°_c�arn
Power Supplier Address
Elechical Conhacfor �Compony Name�
/Q S G,EC-Ti2 /C
Mailing Address (Conhacfor or Owner Performing Insfallafion)
8`7�f1 -v�57��/f V W ZI rr,,
Authorized Sipnature (Contracror or Owner Performinst Insfallation�
1'7Vl � :�'�
Phone No.
�� -�y
0 /y8'
398
Phone
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COPY - SEE INSTRUCl10NS ON BACK OF YELLOW COPY
lic.