P - 82007REQUEST FOR ELECTRICAL INSPECTION �
U�.��J ��- 6 5 8� Minnesota State Board of Electricity
1821 Universiry Avenue Suite S-128, Saint Paul, Minnesota 55704-2993
� (651) 642-0800 www.e%ctricity.state.mn.us
"X" above fhe work covered by this request. Enter remarks in lhis space and on the back of the white copy only.
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Caiculate inspection Fee - This Inspection Request will not be
Ofher Installations Fee # Service E�trance Size Fee
Mobile Home Park Stall to 200 Amps
Sheet Ltg. / Traffic Sig. Above 200 Amps
Transformer/Generator INSPECTOR'S USE ONLY
Sign / Outline Ltg. Xfmr. � Q�
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=p►ed withou� ihe correct fee:
# Circuits / Feeders
0 to 100 Amps
Above 100 Amps
TOTAL
Alarm/Remote Control � `� -/S/<jL /� z6—vl
Swimming Pool
I hereb certi that I ins ted the eledricol insMllotion dexribed herein on the dates slared:
Irrigotion Boom Rough-In
Special Inspection ��'�� � ^ ���
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Investigative Fee
TH15 INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validation date prinfed in this box.
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PLEASE PRINT OR TYPE
`equ�st Dat� Rougffin inspecfion required? Yes ❑ No Inspection Other Than Rough-In: ❑ Ready Now ill Coll
You must call fhe inspecror when ready Date Ready:
I,�licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
Job Address �Street, Box, or Roula No.) � Ciy _ Zip Code
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No.
Mostef Lic. No.
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SEE INSTRUCTIONS ON BACK OF YELLOW COPV