P - 84485. REQUEST FOR ELECTRICAL INSPECTION -_
4�G J-14 5 Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104 �
Phone (612) 642-0800
Home Duplex Apt. Bldg. Other: New Addn
Commerciol Indusirial Farm Remod Re air
ir Cond. Htg. Equip. Water Hfr. Load Mgmt. Other:
Dryer Range Elsc. 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.
Calculate Inspection Fee - This Inspecfion Request will not be accepted without the correct fee:
Other Fee # Service E trance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall # Amp 0 to 100 Amps
Sheet Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPEC70R'S USE ONLY TOTAL
Sign/Oudine Ltg. Xfmr. .��
Alarm/Remote Control
Swimming Pool J�J ,y,�f�, ��1e dar�L�i�/—��
I hereb certi ihat I ins ted fhe elecfrical installa}io'n desc"r�ed herein s�sfa
Irrigation Boom Ro�gh-In Dafe
Speciallnspection "�----"� — —
F��� �,��� 7
Investigative Fee ��,�--�
THIS INSTALLATION MAY BE ORDERED DISCONNE IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requesf void 18 monfhs from validafion date printed in fhis box.
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* � 4 2 5 1 4 5 0�Ic PLEASE PRINT OR TYPE
Requesf Dafe Rough-in inspecfion required? es ❑ No Inspecfion Olher Than Rough-In: ❑ Ready Now ill Call
�„3 ,. � � (You musf call the inspector when ready) Date Ready:
I, ;� licensed conhactor ❑ owner hereby request inspection of the above electrical work at:
Job Address �Sheet, Box, or Route No.) CiN Zio C�e
� Occupant
Z�
d Conhactor
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Address ICc
Range No. Fire No. County �
Phone No.
Addrezs
Conhatlor License No.
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or Owner Performing Installafion�
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icior or Owner Pe ing Insmllafion)
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ST TE BOARD COPY - SEE INSTRUCTIONS
Master Lic. No. �Plant
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Phone NQ