P - 80119REQUEST FOR ELEC7RICAL INSPECTION
� V��- 3 5 7� Minnesota State Board of Electricity a
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0 n f17 �
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ome Duplex Apt. Bldg. Other: �Q � New ddn
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. Enier remarks in this space and on the back of the white copy only.
Calculate Inspection fee - This Inspection Request wiii not be accepled wi►hout the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Pdrk Stall 0 to 200 Amps 0 to 100 Amps
Sfreet Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAi..
Sign/Outline Ltg. Xfmr. � �� „ ��i-/�*�� �/ �
AlarmJRemote Control
Swimming Pool
I r certi that I ins fhe elec ' al insfallafion described herein on the da�es staAed
Irrigation Boom Ro�ghan p�
c.,.._:..i �..___...:_.. _ � /D - 7—oz�_
� Investigative Fee � � � �� q- `'' '�`� y�
THIS fNSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requesf void �months from validation date printed in this box.
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PLEASE PRINT OR TYPE
Requesf Dafe Rou h-in ins ection r uired? ❑ Yes
g p eq ❑ No Inspection Other Than RougMn: ❑ Ready Now � Will Call
g��G.- Q� (You must call Ihe inspector when ready� Date Ready:
I, ❑ licensed contractor [�+Swner hereby request inspection of the above elechical work at:
Job Add�ess {Sheet, Box, w Route No.) Ciry Zip Code
%�� ol � ti / C 1 3 Y3 �-
Secfion No. Township Nome or Range No. Fire No. Counly
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Phone No.
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Pawer Supplier Addr�
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Elecfrical Conha r(Compan� m� Q Conhacfor License No. Master Lic. No. (Plant Elect. Only)
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Mailing Address (C n r or Owner PerForming Insfallafion�
Authori n (Contractor or Owner erformin Instaliafion) Phone No.
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8-0000 _ � 8�96 STATE BOA Y- SEE INSTRUCTIONS ON BACK OF YELLOW COPY