P - 83250REQUEST FOR ELECTRICAL INSPECTION ��'E
6! `'t -� 3� 4� Minnesota State Board of Electricity '- 3
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 Con Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in tl�is space and on the back of the white copy only.
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Calculate Inspection Fee - This Inspecfion Request will not be accepted without the correcf fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobiie Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL, �,�—,JD
Sign/Oudine Ltg. Xfinr. � "�
Alarm/Remote Control
Swimming Pool I hereb certi that 1 ins the eleclrical installafion dexribed herein on ihe dates sta�ed
Irrigation Boom RougMn Dare
Special Inspecti
Find te
Investigative Fee ( � —
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validafion date prinfed in this box.
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PLEASE PRINT OR TYPE
Requesf � Rough-in inspection required? ❑ Yes o Inspection Olher Tha� RougMn: ❑ Ready Now ill Call
�(�`� � �You must call the inspecfor when ready) DaTe Ready:
I, (�licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sheet, Box, or Roufe No.) City Zip Code
i�3 Vin i ss+ �si ►��- r�1 � id l s s� �
Section No. Townshio Name or No. Ranae No. Fire No. Coun
I Occupant
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Phone No.
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Conhacror License No. Master Lic. No.
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ON BACK OF YELLOW COPY