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P - 80331�r-$9�-400 � Farm REQUEST FOR ELECTRICAL INSPECTION � Minnesota State Board of Electricity a 1821 University Avenue Suite 5-128, Sai�t Paul, Min�esota 55104-2993 �; (651) 642-0800 www.electricity.state.mn.us Air Conditioner Htg. Equip. Water Htr. Load Mgmt. Other: Dryer Range Elec. Heat Temp. Service "X" above the work covered by this request. Enter remarks in ihis space and on the back of the white copy �bc,c�-e.� �x.�u�-c.� -�� Ca��e. � 'v C.� . `� ecc.�{.c� -�� �.l.-h [ � -� (�nne c.� ar� Calculate Inspection Fee - This Inspection Request will nof be accepied wiihout the correct fee: Other Installations Fee # Service Entrance Size Fee # Circuits / Feeders Fee Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps Street Ltg. / Traffic Sig. Above 200 Amps Above 100 Amps Transformer/Generator INSPECTOR'S USE ONLY TOTAL L Sign / Outline Ltg. Xfmr. �_,. Swimming Pool I hereb certi that 1 ins cted the elechical installation deuribed herein on the da Irriqation Boom Rouah-In Date � � Investigative Fee � � � � ��-'—Gu � THIS INSTALLATION IIAAY�E ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS. � OFFICE USE ONLY This requssf void 18 months (rom validation date prinfed in fhis box. I�������I���� • a�.� ��I�IIIN�{�� * D 8 9 9 4 0 0 6 * �71J� PLEASE PRINT OR TYPE Request Date Rough-in inspection required$ ❑ Yes ❑ No Inspection Other Than Rough-In: eady Now � Will Call ��� � Q � You must call the inspecfor when ready Date Ready: 1, icensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at: Job Address �Sfreet, Box, or ute No.� � Cit�/ Zip Code 59 v� �V►� J� Section No. Township ame or No. Range No. Fire No. C uny _ _ � Jier , Addre: mtrac(to1r -/ Compan Name , �Lt�� �1 IC �ress (Confracfor, Company or Owner Performing Ins I6 �� ( V' Signature �Contracfor, Company or Owner Performing Ir STATE BnARD COPY Phone No. Conhactor License No. � I MasMr lic. � �� � � �� ��_�U�_�� RFE INSTRIICTIONS ON 9ACK AF YELL�W C[fPY