P - 83648REQUEST FOR ELECTRICAL INSPECTION
4 9. �'f� 918 Minnesota State Board of Electricity
� �821 University Ave., Rm. S-128, St. Paul, MN 55104
� Phone (612) 642-0800 '��
ome Duplex Apt. Bldg. Other: New A
Commercial Industrial Farm Remod e air
Air Cond. g. 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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Calculate Inspection Fee - This Inspection Request will not be accepted 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
Street Ltg./Traffic $ig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL ��
Sign/Oufline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
I hereb certi that I ins fhe electrical installafion dexribed herein on the dates stated
Irrigation Boom Rough-In pa�e
Saeciallnsoecti • . !°. ^`'
� Investigative Fee I ������� �----�_ I V;�'�'�- �-�'O
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requesf void 18 monifis from validation date printed in this box.
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* 0 4 9 4 9 1 8 6* PLEASE PRINT OR TYPE ��'��
Requesf Date Rou h-in ins ecfion r uired?
N�; n I� 9 p eq ❑ Yes o Inspeclion Other Than RougMn: ❑ Ready Now�iNill Call
�� // �-! (You musf call the inspecfor when ready� Date Ready:
I � icl ensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Roufe No.) ` Cify �� Zip Code
Section No. Township Name or
Occuponf
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Power Suoo ier
Mailing Address (Conhactor or
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Address
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