P - 80929$�$-810 �
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REQUEST FOR ELECTRICAL INSPECTION "
Minnesota State BoaN of Electriciry ��.
1827 University Ave., Rm. 5-128, St. Paul, MN 55104 �,
Phone (612) 642-0800 �
Remod
"X" obove �he work covered by rhis reques�. ENer remarks i Ihis space and on fhe back of fhe white copy only.
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Calculofe Inspection Fee - ihis lnspecfion Requesf will no� be accepfed withoW lhe wrr ee:
Other Pee # Service Entrance Size Fre # Circuifs/F¢eders 1
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Sfreef Lfg./TraHic Sig. Above 200_Amps Above 100_Amps
Transformer/Generoior INSPECTOR'SUSEONLY TOTAL ��
Alarm/Remofe CoNrol
Swimming Pool
Irriqa�ion Boom i� M
Imestigative Fee �� � ' � 2'S �-0 V
7HIS INSTALLATION MAY BE ORDERED DISC_ _ � D IF NOT COMPLETED WITHIN 18 MONTHS.
(�� I� I� II I I I II II ��I I II I I I I IIII OFFlCE USE 011LY This request void I B manrhs: olidation d�med i�s 6ox.
* 0 8 2 8 8 1 0 2* �a�
PLEASE PRINT OR TYPE
Reqoest me Q Ro�ghin'mspecnon req�lred? ❑ Yes ❑ No Inspatllon Olher Thon RoughJn: Reody Now � Will Coll
•�S 9/ �Yau musr coll the inspecmr whm reody� Da�e Reody:
I, icensed contmctor ❑ owner hereby request inspection of fhe above electrical work al:
Add�as� �Sheb, Bo., or Ro 0.1 w i rw i n n r.,. �...�e
No. Township Name or No. Ronge
nl �
upplrer �� pddre;
I Connactor �Campany Nome�
_ m � uaroo�
1 Coan Rapids Blv . NW
a R.Ic �-io o,m��9 i�n000r, �I
'�. A-I 1/96 ST e AR� COPY - SEE
��s�s� 9��:
-ror Licensa No Maner Lic No. �PI�
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