P - 82375• REQUEST FOR ELECTRICAL INSPECTION
8�"V � 518 Minnesota State Board of Electricity
j � 1821 University Ave., Rm. S-128, St. Paul, MN 55104 �`
Phone (612) 642-0800 '��'
Home Duplex Apt. Bldg. Other: . New ' Addn
Commercial Industrial Farm � G'1 G Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. O her:
Dryer Range Elec. Heat Temp. Service
"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 accepfed without fhe correci fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders ee
Mobile Home Park Stall 0 to 200 Amps / 0 to 100 Amps
Sireet Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY T TA
Sign/Outline Ltg. Xfmr.
Alarm/Remote Conhol
Swimming Pool ��� s
i hereb certi that I ins th lectrical instaliation described herein on the dates stated
Irrigation Boom Rough-In _ _ Dar�.�.
Special Insp a �s �'�
, � Final - � � �
Investigative ee '
THIS INSTALLATION MAY BE ORDERED DISCONNECYED IF NOT COMPLETED WITHIN 1S MONTHS.
OFFICE USE ONLY This requesf wid 18 monihs from validation date prin��his box.
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PLEASE PRINT OR TYPE
Rec�ues Rou h-in ins on uired? ❑ No Ins
g pecti req �� Yes pection Other Than RougMn: n Ready Now ❑ Will Call
�D (You musf call the inspecfor when ready) Dafe Ready:
I, ❑ licensed contractor � owner hereby request inspection of the above electrical work at:
1ob Address �Streef, Box, or Roufe No.� City Zip Code
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Section No. To ip Name w No. Range No. Fire No. Counly.
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OccuPa Q /� � / ' [ vl i ( Q�Q !� on �d� ! ��! D�O�
Power Supplier Addre
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Elechical Conhacror �Company Name) Contracror License No. Masfer Lic. No. �Plant Elecf. Only)
O t° o wi'I e�
Mailing Address (Con�CClqwor Owner Per(67Y�i�l�l !
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STATE BOARD COPY. - SEE INSTRUCTIONS ON BACK OF YELLOW COPY