P - 83275REf�UEST FOR ELECTRICAL INSPECTION -»�e..
5� L— 5 2 7 Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
, Phone (612) 642-0800
Home Duplex Apt.8ldg. Other: n New Addn
Commercial Indushial Farm �U �" � Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service �
"X" above tfie work covered by tfiis request. Enter remarks in this space and on fhe back of fhe white copy only.
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Calculate Inspecfion Fee - This Inspecfion Requesf 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
Sheet Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator iNSPECroe'S USE ONLY TOTAL� ��
Sign/Oudine Ltg. Xfmr.
Alarm/Remote Conhol
Swimming Pool —
1 hereb ' that I in the electiical in lation described herein on Ihe dotes slaled
Irrigation Boo l'" R«�Mn � ��
Speciallnspection +s..�
Investigative Fee �` — D�
THIS INSTALLATION MAY BE ORDERED CTED IF NOT COMPLETED WITHIN MONTHS.
OFFK:E U8E OIILY ihis requesf void 18 months from validation date printed in this box.
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* � 5 3 2 5 2 7 9* PLEASE PRINT OR TYPE
Request Date Ro h-in ins on �r mred? es
ug pecti eq ' ❑ No Inspection O�her Than RougMn: eady Now 0 wll Call
oC �� 9� (You musT call the inspector when ready) Date Ready:
I, ❑ licensed contractor �' owner hereby request inspecfion of the above electrical work at:
Job Address �Skeet. Bou, w Route No.) Ciy Zip Cade
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Seclion No. Township Name w No, Range No. Fire No. Counly
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•E�-�"�_°ye-' �}�� C.L�i �,� �,�No. �a ^ yo3
Power Supplier Address
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Eleclricol Conkacbr (C y Name) Contraclor License No. Masfer Lic. No. (PIaM Elect. Only�
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Mailing Address �Conhacia or Owner Perfonning Installolion) �
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Authori Si nalure (Conh w Owner Performing InsRolblion) _ 1 Phone No.
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E�00001,41 1 8/96 y�A gpppp �p�r _� INSTRUCTIONS ON BACK OF YELLOW COPY �