P - 82384' , REQUEST FOR ELECTRICAL INSPECTION �
''� o�- 2 2 0 � Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104 -
Phone (612) 642-0800 �� �
ome Duplex Apt. Bldg. Other: ,,,[ New Addn
Commercial Industrial Farm �4 J %C�.� 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 whiie copy only.
Calculate Inspection Fee - This Inspection Request will not be accepted withouf fhe correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generafor INSPECTOR�s usE oN�v TOTAL �O
$ign/Oudine Ltg. Xfmr. �
Alarm/Rem I
Swimming
I hereb certi that I ins the el ' I' sfallafion described herein on the dafes sfaled
Irrigation Boom RougMn / ^ py��•
Speciallnspection � l
Investigative Fee F���I � 7 C� ��S
THIS INSTALLATION MAY BE ORDERED DISCON CTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFPICE USE ONLY This roquest void 18 months from validation date printed in this box.
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PLEASE PRINT OR TYPE
Request Dale Rougltin inspection required? ❑ Yes ❑ No Inspecfion Other Than RougMn: ❑ Ready Now Will Call
(You must call the inspector when ready) Date Ready:
I, ❑ licensed confroctor � owner hereby request inspection of the above elechical work at:
Job Address �Sneer, Box, or Route No.) f Ciry Zip Code
�0 � �v�,K3 (7 rc�c.c l� p �' � �i+ � � .��� 3 Z
$ecfion No. Township Name or No. Range No. Fire No. County
���� r � � i � � o�� Phone No.
lC�'�y/_ �..�r 6� Z- s7 r 3��d t-l-
Power $upplier � ^ � ^ �� � �
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Eleckical Conhactor (Company Name) Contractor License o. Master Lic. No. �Plant Elecf. Only)
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Mailing Address �Conhacfor or Owner Performing Insfallafion)
i So� �, 1�,..�� ��- N �� ���3 �
Authorized Sign (C cror w er P i ns lafion) Phone No.
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E A-1 1/96 OARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY