P - 81524REGIUEST FOR ELECTRICAL INSPECTION
^7 ���� n� Minnesota State Board of Electricity
_� L 1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone(612)642-0800
Home Duplex Apt. Bldg. Other: �� Ne
Commercial Industrial Farm .� �d �' Re
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
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"X" above the work covered by this request. Enfer remarks in this space and on ihe back of the whiie copy only.
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Calcula/e Inspeciion Fee - This Inspection Request will not be accepted without fhe correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to mps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOT
Sign/Oudine Ltg. Xfmr.
Alarm/Remote Confrol
Swimming Pool
I hereb certi that I ins ted ihe electrical insfallation described herein on fhe dates stafed �
Irrigation Boom Rooyh-I� �
$pecial Inspecti '� ` — — �� � l
final q
Investigative F '�-�- ,/
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ON�Y 7his request void 18 months from validation dafe prinfed in fhis box.
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PLEASE PRINT OR TYPE
Requesf Date Rough-in inspection required? ❑ Yes ❑ No Inspecfion Other Than Rough-In: Ready Now ❑ Will Coll
3 ��� �Qq �You must call the inspector when ready) Dafe Ready:
I, �icensed conhactor ❑ owner hereby request inspection of the above electrical work at:
Job Addres; (Streef. Box, or Route Npy� %/��� �� Ci��/ /� Zip Code
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Seclion No. Township Name or No. Range No. Fire No. ounty �A���
30 02 � �[
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Power Sugp`ey. Address
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Electrical Co,�nha/cf.o�r. �(Company Name ,y/
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Mailing Addr ss (Conhaclor or Owner Performing Insfallation)
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Authorized Signa �Co ctor or Ow Performi fallation�
Phone No.
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Con atto License No. Masfer Lic. No. (Planf Elecf. �
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EBOOOOIA-11 8/96 STATE BOARD COPY - SEE INSTRUCTIONS
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