P - 81531' REQUEST FOR ELECTRICAL INSPECTION
Z��� O O� � Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone(612)642-0800
Home Duplex Apt. Bldg. Other: New Addn
Commercial Indushial 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 ihis request. Enter remarks in this space and on ihe back of the whiie copy only.
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Calculate Inspection Fee - This Inspection Reqvest will not be accepfed without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps /' . S�
Sfreef Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLV TOTAL
Sign/Outline Ltg. Xfmr. s. S�
Alarm/Remote Control
Swimming Pool
I hereb certi fhaf I ins fed fhe elecfrical insfallaKon described herein on fhe dates sfated
Irriyation Boom Rough-In pO}e
$peciallnspec' _ r
Fina� p �
Investigative Fee
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void I B monfhs from validafion dafe printed in fhis box.
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PLEASE PRINT OR TYPE
Request Dafe Rou h-in ins ction re uired?
9 Pe q ❑ Yes o Inspection Ofher Than Rough-In: ❑ Ready Now ill Call
� (You must call fhe inspector when ready� Dafe Ready:
I, �licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sheet, Box, or Route No.) City - Zip Code
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Secfion o. Township Na e or No. Range No. Fire No. County
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Occupant � Phone No.
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Power Supplie Address
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Elechical Conhador (Company Name) Conhactor License No. Masfer Lic. No. (Plont Elecf. Only)
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Mailing Addreu (Confractor or Owner Performing Ins�allaKon)
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Authorized Si tu (C acror or Owner ing I Ilation� � Phone No.
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Eg00001A-1 1 8/96 S AT ARD COPY - SEE I ON BACK OF YELLOW c[�av