P - 80732REGIUEST FOR ELECTRICAL INSPECTION ��
O(1 � m��� � Minnesota State Board of Electricity
� �•% 1821 University Ave., Rm. S-128, St. Paul, MN 55104
+ Phone (612) 642- 00
Home Duplex Apt. Bldg. Other: 0 —�'�, New Addn
Commercial Industrial Farm �� �� Remod Re air
Air Cond. Htg. Equip. Water Hh. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" abo e the work covered by this request. Enier 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 without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps _-
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR•s use oN�r TOTAL �l
Sign/Oudine Ltg. Xfmr. �'L g-� � �/
Alarm/Remote Conhol � . � - G 'Y'L'
Swimming Pool �i2 � � ' � � � �
I hereb certi that I ins the eleclrical installa ion described herein on the dates stated
Irriyation Boom RougMn d Dare
Specialinspech �/
Daf�.� !/?�L._
Investigative Fee ^--��- ti
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validation date printed in this box.
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PLEASE PRINT OR TYPE
Request Date RougfFin inspeclion required? ❑ Yes ❑ No Inspecfion Other Than Rough-In: ❑ Ready Now ❑ Will Call
(You must call the inspeclor when ready� Date Ready:
I, ❑ licensed co tractor ❑ owner hereby request inspection of the above elechical work at:
Job Address (Sheet, Box, or Route No.� Ciy . , Zip Code ,
� Seclion
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F,ounry �/�CJ /�-��(
Phone No.
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Power upplier Addre
S �'..�, �� C!,
Elecirical Contracror (Company Name) Contr r License No. Master Lic. No.
I Mailing Address �CyphacYOr or Owner Performing Insfallafion� �
A �Al.n 1 �
or
A-1 1
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S ON BACK OF YELLOW COPY