P - 80279.
8.���175 �
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Dryer
"X" above the work
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REQUEST FOR ELECTRICAL INSPECTION ��
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104 �
Phone (612) 6 2-0�0 `.��
Apt. Bldg. Other O New Addn
Farm �' � Remod Re air
Water Htr. Load Mgmt. Ofher:
Elec. Heat Temp. Service
request. Enter remarks in this space and on the back of the white copy only.
Colculate Inspection Fee - This inspeciion Request will not be accepted without fhe correc► fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders
Mobile Home Park Stal� 0 to 200 Amps 0 to 100 Amps
Street Ltg./Tra(fic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR•s u NLY TOTAL
Sd ��} �� /� — � z- 4.–°� cJ
Sign/Outline Ltg. Xfmr. $3� –TS,,� /
Alarm/Remote Conhol �`� � ��
Swimming Pool ��
1 hereb certi that I ins ihe electr' tallation described herein on rhe dates stated
_ Irrigation Boo • RougMn � _. Datq �, �
Fee
,.7 V
lnvestigative Fee ��� � �Qd
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 �AQNTHS_ _
OFFICE USE ONLY This request void 18 months from validation date prinfed in this box. ,
� IIl� �� i�l II �I� �� �� � �`�� '�f
I I I I I I I III �II�I III � n! I illl
* 0 8 0 2 1 7 5 0* �� /
PLEASE PRINT OR TYPE
Requesf te /� Rough-in inspecfion required$ Yes ❑ No Inspecfion Other lhan RougMn: ❑ Ready Now Will Coll .
� j� ^ D(/ (You must coll fhe inspector when ready) Dafe Ready:
I, ❑ licensed conlractor � owner hereby request inspection of the above electrical work at:
kb Addreu (Sheef, Box, or Route No.) Ciiy Zip Code
S`1 � S�
Secfion No. Townshio Name or No. Ranqe No. _ Fire No. Co �
Occupant
M �
�sr
I Conkaclor �
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Address (Co�
ed Signalure
t . /
Owner
0
0
Phone No.
6 I Conhactor License No.
r Aat�C � /l��a�`� �
- SEE INSTRUCTIONS ON BACK OF YELLOW COPY