P - 82371� REQUEST FOf� ELECTRICAL INSPECTION
C i`tJ [� 218 Minnesota State Board of Electricity
, 1821 University Ave., Rm. S-128, St. Paul, MN 55104 =
Phone (612) 642-08 0 � J� '� �
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Home Duplex Apt. Bldg. Other: t O (' f New Addn
Commercial Industrial Farm , � 1 Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" ve the work covered by this request. Enter remarks in this space and on the back of the white copy only.
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Calculafe Inspection Fee - This Inspeciion Request will r,ot be accepfed without the correct fee:
Other Fee # Service Eotrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Sfreet Lig./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL !
Sign/Outline Ltg. Xfmr, ��1 JO�[ T�r�c^7/ ��O.S�
Alarm/Remote Conhol ���+ �-� �� fi , l�� �L
Swimming Pool
I hereb certi that I ins ihe elechical installation dexribed herein on the dates stafed
Irrigation Boom RougMn Dare
-Speciallnsp '
Final
Investigative Fee G Q �@J�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requesf void 18 monihs from va��; te printed in fhis box.
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PLEASE PRINT OR TYPE �
Request DaJp Rough-in inspeclion required$ ❑ Yes No Inspection 01her Than Roughdn: ❑ Ready Now ill Call
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�,J �You musf call fhe inspector when ready) Date Ready:
I, ❑ licensed contractor wner hereby request inspection of the above eleckical work at:
Job Addreu �Sfreet, Box, or Roufa No.) Ciy Zip Code
S 7�'�f �'�r��/L-s o•., s�-- � t� �'sy3 L
Secrion No. Township Name or N� � Ran� o. Fire No. Coun
o �o�
OccuApa�nf Phone No.
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Power Supplier Address ,/�
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Elechicol Confmcfor �Comp�ylVamel � � Conhacfor Gcense No. Master Lic. No. ( anf Eleci. Onlyl
� Mailing Address (Confracfor or
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