P - 81221RE(1UEST FOR ELECTRICAL INSPECTION
V�� - 8 5 2� Minnesota State Board of Electricity
1821 Universiry Ave., Rm. S-128, St. Paul, MN 55104
�' Phone (612) 642-0800
Home Duplex Apt. Bldg. Other. ew ddn
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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Calculate inspec►ion Fee - This inspeciion Request will not be accepied without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps j 0 to 100 Amps 6,°�
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTgLO S�
Sign/Outline Ltg. Xfmr. �J�,u,� _ � j—U C7l '"
Alarm/Remote Confrol
Swimming Pool
I hereb certi thaf I ins fhe elechical installation described herein on Ihe dotes slated
Irrigation Boom RougMn Dnre
Speciallnspec �
Final
Investigative Fee O — — ��
THIS INSTALLATION MAY BE ORDERED DISCON ED IF NOT COMPLETED WITHIN 18 MONTHS.
... _.- OFFICE USE ONLY This request void 18 months 6om validation date printed in this box.
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*08278525* �3a-7
PLEASE PRINT OR TYPE
Requesf Dafe Rough-in inspecfion required$ ❑ Yes �4Eo Inspecfion Other Than RougMn: �ady Now � Will Call .
�►�. � �You must call the inspector when ready) Date Ready:
I,�icensed confractor ❑ owner hereby request inspection of the above elechical work at:
Job Address (Street, Box, w Route No.) Ciry Zip Code
1 b o `�- ✓u:
Section No. Township Nome or No. • Range No. Fire No. Couny
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Occupopnt Phone No.
7„�t,�,_ �u�„, �IL S 14 logy
Power Supplier � - � Address
Conhncfor �Company� Name� Conhacfor License No. Masfer Lic. No. (Planf Elecf.
�t�'.�1 L- � +� Qi 7�a ('.la-O �310 i"
.ddress (Conhaclor or Owner Perfwmi� Insto IaKon) /' �
�V' �4.�,,,P. �� SS'
d Signa o r n I n � Phone No.
'752 f ss� -�� � �
-1 6 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY