P - 80981� REQUEST FOR ELECTRICAL INSPECTiON -
��C�� 2� 4 Minnesota State Board of Electricity
a� 1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone(612)642-0800
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial 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 this request. Enter remarks in this space and on the back of the white copy only.
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Calcula�e Inspection Fee - This Inspec►ion Request will not be accepted withoui the correci fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall f 0 to 200 Amps 30�� 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Abov Amps �O. •
Transformer/Generator INSPECTOR'S USE ONLY TO�T,I,r�O s�
Sign/Outline Ltg. Xfmr. / .
AlarmjRemote Conhol
Swimming Pool
I hereb cerfi that I ins ed the elechical insrollallon deuribed herein on the dates stafed
Irrigation Boo RougMn Dme
Special Insp ,
find � r
Investigative Fee —j
THIS INSTALLATION MAY BE ORDERED DISCO NECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validafion date printed in this box.
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PLEASE PRINT OR TYPE
Request Date Rou h-in ins ion uired$
/� g pect' req � � No Inspeclion Other Than RougMn: ❑ Ready Now �.N/ill Call
T�(> (You must call the inspector when ready� Date Reody:
I, �licensed contracror ❑ owner hereby request inspection of the above elechical work at:
Job Address �Sfreet, Box, or oute No.� City . Zip Code
Lf o l�/lu.�-� -d�t-. �
Section No. Township Name or No. Range No. fire No. nty _
Power Supplier
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Electricai Conhacfor �ComF
Mailing A dress (Conhacfc
S33 � �
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�contru�ro. o. (Swn� I
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STATE
Phone No.
Conhacfor License No. I Masffir lic. N
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Phone No. /
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INSTRUCTIONS ON BACK OF YELLOW COPY