P - 81114REQUEST FOR ELECTRICAL INSPECTION
8 A�. ��� � Minnesota State Board ofi Electricity
�t 1821 University Ave., Rm. S-128, St. Paul, MN 55104
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, Phone(612)642-0800
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Re air
ir C Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. $ervice
"X" above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
Calculate Inspection Fee - This Inspection Request will not be accepted wifhout fhe correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Slreet Ltg.jTraffic Sig. Above 200 Am s Above 100 Amps
TransformerjGenerator INSPECTOR'S USE ONLY TOTAL G
Sign/Oudine Ltg. Xfmr. � ���
Alarm/Remote Conhol
$wimmiil9 Poo� I hereb certi ihat I in the elechical insmilation described herein on the dates stated
Irrigation Boom Ra9M� pare
Special Insp
Fiypl oose �
Investigative F �—Z$L a
THIS II�STALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 monfhs from validation date printed in this box.
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PLEASE PRINT OR TYPE
Request DoA�e Rough-in inspection required$ ❑ Yes No Inspection Olher Than RougMn: Ready Now � Will Call
��i'%� � (You musf call fhe inspecfcr when ready) Date Ready:
I, licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address �Street, Box, or Route No.) Ciy � Zip Code
/9i� G��erf .sTi+�E Fr�� e
SeMion No. iownship Name or No. Range No. fire No. County
�} no �
Occupant . Phone No.
ran �c.. l�l �n r c� 7F'G - �6�0 2_
Power Supplier Address
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Eleclrical Contracror (Company Name� Contracror License No. Master Lic. No. �WaM Elect. OntyS
,27�sEt�c'r'�e�� ��t-oiY�
Mailing Address (Conkacfor or Owner PerForming Insfallafion)
8�� �.S'yZ� �ve N4� 2�rr,.�, . r�'!h . 3�339ef`
Authorized Signature (Contracfor or Owner Performing Insfallation) Phone No.
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EB-00001 A-11 8/96 STA AR OPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY