P - 82937REQUEST FOR ELECTRICAL INSPECTION �_�.
5���� C(i �q 0 Minnesota State Board of Electricity
0 � 1821 University Ave., Rm. S-128, St. Paul, MN 55104
, Phone (612)642-0800
Home Dup{ex 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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Calculate Inspection Fee - This Inspection Request will not be occepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps Q to 100 Amps
$treet Ltg./TrafFic $ig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
Sign/Oudine Ltg. Xfmr. .��' ��
Alarm/Remote Conhol
Swimming Pool
I hereb certi that I ins the electrical installation descri6ed herein on Ihe dates staled
Irrigation Boom Roughin p�
Speciallnspect' ` �
Investi9ative Fee F��I � � �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
� OFHCE USE ONLY This request void 18 months from validation date pri�ted in this box.
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* � 5 3 3 9 6 9 2 y!c PLEASE PRINT OR TYPE
Requesf Date Rough-in inspecfion r uired$ ❑ Yes pecf ougM ❑ Reody Now � ill CaH
eq ❑ No Ins �on Other Than R n:
�—/� �'f ((� (You must call fhe inspector when ready) Dafe Ready:
I, �icensed contractor ❑ owner hereby request inspection of the above elechical work at:
Job Addreu (Streef. Box or Roule No.I Ci P
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Secfion No. Township Name� or No. �� Ra�ge No. Fire No. ounty �
r'�.vaki�
Occupant Phone No.
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Power Supplier Address
Elechical Confracbr �Company Name) Conhador License No. Masfer Lic. No. (Planf Eled. Only)
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ili Address �Confractor or Owner_Performi Inslallafion) � � ���i' �
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Authorized $ig (Confracfor or Owner P ' in�InsMlla6 • Phone No. �±
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E 1 A-11 8/96 �p� BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY