P - 80816REQUEST FOR ELECTRICAL INSPECTION
8������ � Minnesota State Board of Electricity
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" abovC� ork 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 accepfed wiihout the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall � 0 to 200 Amps i 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
Sign/Oudine Ltg. Xfmr. � �
Alarm/Remote Control
Swimming Pool
I hereb certi thaf I ins ted the elechical installation described herein on ihe dates stated
Irrigation Bo �f ? /� RouaMn Dare
Investigative Fee ���� �_ Z
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
____ OFFICE USE ONLY This requesf wid 18 months from validati da pnnted ia this x.
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PLEASE PRINT OR TYPE �� J '�
Request D Rough-in inspecfion required$ ❑ Yes o Inspecfion O�er Than RougMn: ❑ Reody Now ill Call
7 (You must call the inspector when ready) Date Ready:
I,�icensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sheef, Box, or Route No.� ily Zip Code
L � / — V � � �'G/
Secfion No. Towns ip Name or No. Range No, ve No. County
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Address
lor (Company Name) �i` � � _ Conhactor Licen� �'! �/V ! �Ma�Lic. No. (Plant
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r/ �Y .,�
;Confracfot or Owner PerForminp Insfallationl � ts�
No.
STATE BOARD COPY - SEE INSTRUCT10N5 ON BACK OF YELLOW COPY