P - 83948REQUEST FOR ELECTRICAL INSPECTION
5`t (-} = 4 4 9 Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104 �`i
�` Phone (612) 642-0800
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm ' �l ; t w.-�.. 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 wfll n e accepted wiihout the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 t 100 mps
Street Ltg./Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL�
Sign/Outline Ltg. Xfmr. .
Alarm/Remote Control
Swimming Pool
� hereb certi that 1 ins ed the elechical insfallation described herein on the dates stated
Irrigation Boom Rough-In oare
Special Inspecti i
Final � , D e ` �
Investigative Fee
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFRCE USE ONLY This requesf void 18 months (rom validafion date prinfed in fhis box.
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* � 5 4 4 4 4 9 2* PLEASE PRINT OR TYPE
Requesf afe Rough-in inspection required? ❑ Yes o Inspecfion Ofher Than RougMn: Ready Now Q Will Call
��?`�� (You musf call the inspector when ready Date Ready:
I, censed contractor ❑ owner hereby request inspection of the above electrical work at:
1ob Address (Sfreet, Box, or Rou No.� Cify �_/�� Zip Code
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Section No. Township Name or No. Range No. Fire No. Co y /,i /
Ocwpant /'/�� ��
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Phone No.
Power Suppli �� Address Q//� /%/L'� �`V l
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Elech' Co f r �Company Nam Confracfor License No. Masfer Lic. No. �Planf Elecf.
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(Conhactor Owner Performing
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ifure onf actor or Own rfqir
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