P - 80952REQUEST FOR ELECTRICAL INSPECTION �."'�'�'� ��
6�'7 � p 6 C Minnesota State Board ot Electriciry I
r �i C� 1821 Universiry Ave., Rm. 5-128, St. Paul, MN 55104
�. Phone (612) 642-OS00 �%�t. �� I.
Home Duplex Apf. Bldg. Other: New Addn
Commerciol Industrial Farm Remod Re oir
Air Cond. Hfg. Equip. Wofer Hfr. Load Mgmt. Ofher:
Dryer Range Elec. Heat Temp. Senice
"X" obove Ihe work covered by this requesG Enter remarks in fhis space and on Nie back of the while copy only.
�B.�nSn.'� � � r� � S�.
Calculofe Inspec�ion Fee - This Inspection Requesf will not be occepled wifhouf rhe correc� fee: I
Other Fee # Service EMrance Size Fee # Circuits/Feeders Fee ��
Mobile Home Park $tall 0 to 200 Amps 0 to 100 Amps
Slreet Ltg./TmNic Sig. Above 200_Amos Above 100—Amps
Tronsformer/Genemfor INSPECiOH'S USE ONLY TOTAL
Sign/Oudine Lfg. X(mr. . �
Alarm/Remofe Control
$wimming Poa� i hereb cen� �har I ��s c�ed rhe elearical msiallacon described here�n on ihe dmes sm�ed
Irrigafion Boo ( CyM� ,� '_ Dare _ Z �, �
Special Inspecfion
Investigofive Fee F�� – � � — C� �
THIS INSTALLpTION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 78 lNONTHS.
I� II III (I III II �I II III � I I II I(� III I�I OFFICE USE ONLY This reqoes� votd 18 mom�m wlidotion da�ied� box.
* 0 6 5 7 4 6 6 9* ��O g
PLEASE PRINT OR TVPE
Reques� Dule Roogh-in inspecnon required? Yes ❑ No Inspenion O�her Than Rwgh-In: ❑ Reody Now Will Coll
%� .. 1 a�q (Yoo mus� coll ihe inspecror whe� reody� Ome keody:
I, � licensed coniractor � owner hereby request inspection of Ihe above electrical work ot:
Job Address �Sneer, Bo Rome No.� Ciry Zip Code
1 �o.i bn �r' � SS �-13�
Senion No. Township Name ar No. Rvnae No. Fire No. C _
Phone No.
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re (Contr� Owner P 'ng Insml ' � � � (� P
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'� _ STATE BOAAU COPY - SEE INSTAUCTIONS ON BACK OF YELLOW COPV
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