P - 80713REQUEST FOR ELECTRICAL INSPECTION
7�` � ��, ��� � Minnesota State Board of Electricity s
V, 1821 University Ave., Rm. S-128, St. Paul, MN 55104
, Phone (612) 642-0800 '�"
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm ,M i�113'+� �Lk�,�i v� Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Neat Temp. Service
"X" above the work covered by this request. Enter remarks in ihis space and on the back of the whiie copy only.
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Calculate Inspection Fee - This Inspection Request will not be accepted without ihe correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps � j� 0 to 100 Amps �
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps �
TransformerJGenerotor INSPECTOR•s use oN�v �� �,� � TOT !_ s�
Sign/Outline Ltg. Xfmr. � � ' r
Alarm/Remote Control
Swimming Pool
1 hereb certi ihat I ins ected the elechical insfallation described herein on the dafes stated
IrrigationBoom Ro�yMo �Ty� D�^�7� e�
Speciaf inspectio ' ��
✓ Final _� Q
Imestigative Fee — /
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
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. OFFICE USE ONLY This request void 18 months from validafion dafe prinfed in this box.
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PLEASE PRINT OR TYPE �
Requesf Dafe Rough-in inspecfion required� ��Yes ❑ No Inspecfion Other Than RougMn: ❑ Ready Now 0 Will Call
'�'1 .,, q' �You must call the inspecfor when ready� Date Ready:
I, �censed contractor ❑ owner hereby request inspection of the above electrical work at:
lob Address (Sheet, Box, or Route No.� � City Zip Code
��,� aNBN�[�Cre1 �t" ��'�.�L.��
Seclion No. Township Name or No.
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Occupant
PowerSupplie,�� �
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Elechical Conkactor (Company Name)
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Mailing Address (Conka `tor or Owner
vy
Aufhorized Sign ( aclor O�
&qpG A-11 8/96
,+ �
Address
Couny
A
Phone No.
Conhacfor License No. Masfer Lic. No.
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� Installation) .
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