P - 83106REQUEST FOR �LECTRiCAL INSPECTION
5^7 �� C O'1 m 0 Minnesota State Board of Electricity
, V 1. 1821 University Ave., Rm. 5-128, St. Paul, MN 55104
Phone (612) 642-0800 " '
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Re ir
Air Cond. Htg. Equip. Water Htr. Load 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 white copy only.
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Calculate Inspection Fee - This Inspection Request will no► be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall � 0 to 200 Amps ��� 0 ro 100 Amps
Street Ltg./TraRic Sig. Above 200 Am s Above 100 Amps
Transformer/Generaror INSPECTO/R'S USE ONLY TOTAL
Sign/Oudine Ltg. Xfmr. ,�?�,Tt/� � a$• SV
Alarm/Remote Conhol
Swimming Pool
I hereb certi that-1 ins fhe electrical insmllation dexribed herein on the dares stoted
IPrigation Boom RougMn � � . . .� Dafe
Special lnspec
Final
Imestigative fee` � 2 �
THIS INSTALLATION MAY BE ORDERED ONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
-- OFFICE USE ONLY This request void 18 monfhs from validafion date printed in this box.
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Request Date Ragh-in inspection required2 ❑ Yes �'IVo Mspeclion Olher Than RougMn: �Q'I�eady Now � Will CaN
3'� Z,7—� (Vou must call the inspec�or when reody) pafe Ready: _ Z7,� .^.J �
I, �censed confractor ❑ owner hereby request inspection of the above elechicai work at:
Job Address (Sheet, Box, or Roufe No.) Ciry Zip Code
13lo Zire� � �rr`dlt 5y,3�
Seclion No. Township Name r No. Range No. Fire No. County
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Occupant Phone No.
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P� � ClN Ci -
Power Supplier Address
/U. $ , I�
tlectrical Conhactw �Company Name�
l3 K L.t Et�c-r�'Lt
Mailing Address (ConfraMOr or Owner Perfo
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� ori Signature �Contr� or Owner I
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E A-11 8/96 STA7E
Conhacror Lia
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SEE INSTRUCTIONS ON BACK OP YELLOW COPY