P - 80662REQUEST FOR ELECTRICAL INSPECTION
7�(�,�,� Q Q C� � Minnesota State Board of Electricity �
. �� �� �� 1821 University Ave., Rm. S-128, St. Paul, MN 55104
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Phone(612)642-0800 " '
Home Duplex Apt.8ldg. Other: New Addn
Commercial Indusfrial Farm Remod Re air
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 not be accepted withouf the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Am s
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
Sign/Outline Ltg. Xfmr. . 50
Alarm/Remote Control
Swimming Pool
I here6 certi that 1 i� the eleclrical installafion described herein on the dotes stated
Irriaation Boom e,,,,..�„ n„�
Investigative Fee F��I � J�C �� : f ��
THIS INSTALLATION MAY BE ORDERED DtSCO ECTED IF NOT COMPLETED WI IN 1 MO THS.
OFFlCE USE ONLY This request void 18 months from validotion date printed in this box.
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PLEASE PRINT OR TYPE
Requesf Dafe (yn Rough-in inspection required2 ❑ Yes o Inspection Other Than Rough-In: ❑ Ready Now ill Call
lQ � a'3 ^'�"� �You must call the inspector when ready) Dafe Ready:
I, licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Jo6 Address (Streef, Box, br Roufe No.) Ci Zip Code
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Secfion No. Township Name or No. Ronge No. Fire No. County � I
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Occupant��� � �^ Phone No.y �
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Power Supplier
I Conhacfor �Com any Name � Contractor{icense No. I Masfer�Lic.
BLAINE HTG. A,C �LECT., iNG /� � � _, � / _
�� er r Pe� rmin�lnsta�� �/�y � A� I Phone No. ��
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STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY