P - 83278REGIUEST FOR ELECTRICAL INSPECTION �
6 i� �- 4 3 4� Minnesota State Board of Electricity �
, 1821 University Ave., Rm. 5-128, St. Paul, MN 55104 �
' Phone (612) 642-0800 '�'
Home Duplex Apt. Bldg. Other: New ddn
Commercial Industrial Farm Remod Re ir
Air Cond. Htg. Equip. Water Htr. Lood Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on the back of the whiie copy only.
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Calculate Inspection Fee - This Inspection Request will not be accepted without ihe correct fee: �- `"� 7��
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps O�
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generafor INSPECTOR'S USE ONLY T TAL �r-�
$ign/Outline Ltg. Xfmr. � 3�, �-X/
Alarm/Remote Conhol
Swimming Pool
I hereb certi that I ins the elechical insmllaiion dexribed herein on the dates stated
Irrigation B RoogMo Dare j�
Speciai Insp i b � �+
Final
Investigative Fee '
THIS INSTALLATION MAY BE ORDERED DISCO D IF NOT COMPLETED WITHIN 1 MONTH .
OFFICE USE ONLY This request void 18 months from validation date printed in ihis box.
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PLEASE PRINT OR TYPE
Requesf Dafe � RougMin inspection required? es ❑ No Inspecfion Other Than Rouglfln: ❑ Reody Now ❑ Will Call
q� 2���� (You must coll the inspector when ready) Date Ready:
I, �licensed contracror ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sheet, Box, or Roule No.) City Zip Code �
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Secfion No. Township Name a No. Range No. Fire No. County
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Power S�lie� Addres�
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Elechic� acb� om _pany Name/C � �/� Conha�r L�cense No. Masfer lic. No. (Planf Elect. Only)
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Mailing Addreu (Confractor or e rming I�stallation) Q
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Aufhorized Si naNre Conha or C�wner o'n• IlaTion) '�� j:� Phone No. /J�.�
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EB-OOOOIA-i l 8/96 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY