P - 82288_,
8��-214 �
Home Duplex
Commercial Industrial
Air Cond. Htg. Equi
Dryer Range
"X" above the work covered b
REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104 �
Phone (612) 642-08Q0�� `'�'
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� Other: � _ �C New Addn
Farm /^ Ti Remoc
Water Htr. Load Mgmt. Oth r:
Elec. Heat Temp. Service
this request. Enter remarks in this space and on the back of the white copy
Calculate Inspecfion Fee - This Inspection Request will rot be accepted without the correcf 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 ONLY TOTAL „�/ S�
Sign/Outline Ltg. Xfmr. �j
Alarm/Remote Conhol
Swimming Pool
I herebvi certiH that I insoected the elechical installation described herein on the dales stated
Final �_
Investigafive Fee F � `
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requesf void 18 months from validafion date prinfed in ifiis box.
I II�I 1� �II I� I�I II III II III II �II �� � � D
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PLEASE PRINT OR TYPE
Request te Rou h-in ins ion r
g pecf equired2 ❑ Yes No Inspection Ofher Than Rough-In: ❑ Ready Now Will Call
° Q2 �� (You must call fhe inspector when ready� Date Ready:
I, ❑ licensed contractor ❑ owner hereby request inspection of the above electrical work at
Job Addreu �Sheef, Box, or Roufe No.) City � Zip Code
7 d do r•N`,I� � d� sS'3�
Secfion No. Township Name or Ny� Ranpe No. Fire No. ounty
Occupant
Power Su� r� G � �'
.v's P
Elechical Conhactor �Company Na
Mailing Address (Conhgctar�or Owner
�'vv�
Phone No.
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Conhador License No. Master Lic. No. �Plant Elec1. Onl
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ja i anire �t.onrta r or ner Yertorm g sfallation) Phone No.
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8/96 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY