P - 8147765�-464
Home Duplex
Com merc ia l Ind ustrial
Air Cond. Htg. Equi
Dryer Range
"X" above the work covered b
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REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800
Apt. Bldg. Other: t New Addn
Farm u�'+ �. Remod Re air
Water Htr. Load Mgmt. Other:
Elec. Heat Temp. Service
request. Enter remarks in this space and on the back of the white copy only.
Calculate Inspection Fee - This Inspeciion Request will not be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Ai
Transformer/Generator INSPECTOR's uSE ON�r TOT,
Sign/Outline Ltg. Xfmr. •
Alarm/Remote Control
Swimming Pool
Fee
I hereb certi thaf I ins ted fhe electrical installation dexribed herein on the dafes sfated
Irri9ation Boom Rough-In Dore J�j
Special Inspecti • t '_� '? � ^ZS_" '
Final - Date
Investigative Fee � � ^ ��
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requesf void 18 monihs 6om validafion date printed in this box.
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PLEASE PRINT OR TYPE
Requesf Date Rough-in inspecfion required? Yes ❑ No Inspection Other Than RougMn: ❑ Reody Now Will Call
��� ��� (You must call fhe inspecfor when ready) Dafe Ready:
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sfreef, Box, or Route No.) Ci Zip Code
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Secfion No. Townshio Name o. Ronqe . Fire No.
Occupant
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Power Suppier
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Elecfrical Confractor (Company Name)
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Mailing A s �Conhactor or Owner Performing Installat n
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Authoriz ' na re (Conh�ner ormi Installi
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Phone No.
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ontracror icense No. Mastei Lic. No. (Plant Elecl
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