P - 83098REQUEST FOR ELECTRICAL WSPECTION
6!�i�� ° 3 2 3� Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
� Phone (612) 642-0800
i'
Home Duplex Apt. Bldg. Other: New dn
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 ihe white copy only.
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Calculafe Inspection Fee - This Inspection Request will noi be accepted 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
Sfreet Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY T TAL, �
$ign/Outline Ltg. Xfmr. nA„ � G � j�%,, „�� t� '�s
Alarm/Remote Confrol ���� �J����i �
Swimming Pool Lt��'�
I hereb certi that I ins ted fhe elechic I instollation described herein on the dafes sfated
Irri9ation Boom ♦ RougMn Dar � � �
Speciallnspec -
Final
Investigative Fee � ;I�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validotion dafe prinfed in ihis box.
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PLEASE PRINT OR TYPE
��5� I� � Rou h-in ins ection re uired? es
�+, � g p q ❑ No Inspection Other Than Rough-In: ❑ Ready Now ill Call
(You must call the inspector whe ready) Date Ready:
I, �licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sheef, Box, or Rouie No.) City Zip Code
I�0 �/ N�E R ID�� �Sy3 �
Secfion No. Township Name or No. Range No. Fire No. Couny
Occupant Phone No.
S i�E�.ld� CO
Power Supplier Address
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Eleclrical Confractor (Company Name) Conhaclor License No. Master Lic. No. �Plant Elecl. Only)
K �NG E�c-r�� n� c c��-��
iling Address (Conhacfor w Owner Performing Installation)
c� gox �4� Cr�ecc,� t�IN�/�N �5a1
Auth ri Signature ( nhacfor or��Owner Performing o r Phone No.
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EB-00001 A-11 819d STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY