P - 83585REQUEST FOR ELECTRICAL INSPECTION
7 � �� n� O � Minnesota State Board of Electricity �
� c 1821 University Ave., Rm. S-128, St. Paul, MN 55104 �`
, � Phone(612)642-0800 " '
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm 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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Calculaie Inspection Fee - This Inspeciion Request will not be accepted without the correct fee:
Ofher 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�v TOTAL \
Sign/Ouiline Ltg. Xfmr. �.S , �"rV
Alarm/Remote Conhol
Swimming Pool
I hereb certi that I ins ted the elechical installation described herein on the daTes siated
Irrigotion Boom RougMn Dare
Special Inspection
Finol Da
Investigative Fee � - ._ ``Z,2
THIS INSTALLATION MAY BE ORDERED DISC TED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requesf void 18 monfhs from validation date prinfed in this box.
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PLEASE PRINT OR TYPE
Request Date Rough-in inspecfion required? ❑ Yes No Inspecfion Other Than RougMn: ❑ Ready No ill Call
�/� � � y^� (You musf call ihe inspector when ready) Dafe Ready:
I, �icensed conhactor ❑ owner hereby request inspection of the above electrical work at:
Job Address �Sheet, Box, or Roufe .) 1 Zip Code
� � � � r a.. W r : � .Q, SS`ai3�
Section No. Township Name w No. Range . Fire n �
Occvpanh - Phone No.
/ / � � . 1/� iYti. �l 1r.� � � . �t' % �i V� � / ! � .S . \ /
Power SuppliOF � Address /
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Elecfr' I Conhacfor �Company Name�I I Conha tor License No. Masfer Lic. No
�Y`Q@2R. �(e�,Tr•� � �� �d �l�
Mailing Address �Conhacror or Owner Performing Installafion)
2s�'S' t 3°r�-�- � L.a �V � S30
Authorized S' atur ( onh r ner Perfor ' I' n� Phone No.
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E&OOOOIA-1 1 8/96 TA BOAHD CO - SEE INSTRUCTIONS ON BACK OF YELLOW COPY