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Home Duplex Apt. BI
Commercial Industrial Farm
REGIUEST FOR ELECTRICAL INSPECTION ���:::° ,
Minnesota State Board of Electricity �
1821 University Ave., Rm. S-128, St. Paul, MN 55104 �����_.�
Phone (612) 642-0800 a�
Other: New Addn
Remod Re�air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other: , S�
D er Ran e Elec. Heat Tem . Service �/
C' above the work covered by this request. Enter remarks in this space and on the back of the white copy
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Calculate Inspection Fee - This Inspection Request will not be accepted withouf the correct fee:
Other Fee � Service Enirance Size Fee # Circviis/Feeders Fee
Mobile Home Pork Stall 0 to 200 Amps �j 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY T� ��, � D
$ign/Outline Ltg. Xfmr. .., ��� t.L-� C�na' l�/ °'
Alarm/Remote Conirol �
Swimming Pool
I hereb cerfi fhat I i es� ' a inslallafion des
Irrigation Boom Rough-In �
Special Inspedion
Final
Investigative Fee
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT CQI�PI
2 9 9- 3 91 j� OFFlCE USE ONLY This request void 18 months from validafion
Date
�,� �� _
ED WITHIN 18 MONTHS.
prinfed in ihis box.
• ��.
2 5 � 2 /Z�'��� # .�� yr �i��s-d
PLEASE PRINT OR TYPE
Req�est Dok � Rough-in inspecfion required2 � Yes � No Inspeclion Olher Thon Rough-In: � Ready Now � Will Call
� � Gf (You must call the inspedor when ready) Date Ready:
I, ❑ licensed contractor �owner hereby request inspection of the above electrical work at:
Job Address (SNeet, Box, or Route No.) Ciy Zip Code
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$ecfion No. Township Nome or No. Range No. fire No. Coun
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Name)
��
Address
No.
Confrador License No. � Master
Mailing Address (Conirador or Owner Perfoiming Instollation)
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Aufhorized Si tum (Co�frattor or Owner Performing Install tion) Phone No.
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EB- A-10 6/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY