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RE(1UEST FOR ELECTRICAL INSPECTION �.
Minnesota State Board of Electricity
1821 University Ave., Rm. 5-128, St. Paul, MN 55104 �:
Phone(612)642-0800
Aot Rlda_ Other. New Addn
Farm
�. Water Htr. L<
Elec. Heat T�
� ihis request. Enter remi
'vlgmt. Other:
Service
in this space and on the back of ihe white copy
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 00 Am � 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR°s use oN�v T0�4L ��
P
Sign/Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool �-' �—cl
I hereb certi that I ins ected the electric ' stallation described herein on th9 ates tated
Irrigation Boom Rough-In . �a�
Special Insp �' �+s- / '� - Z - �t
Final f � `�'s-
Investigative Fee - - -
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WIT IN 18 MONTHS.
OFFICE USE ONLY This requesf void 18 months 6om validation dafe printed in this box.
IIIIIIIIIIIIIIiIIIIIIIIiIIIIII11�11IIIIIIIIIIIII �� • -
* O 4 O O`I O B O* PLEASE PRINT OR TYPE--����
Request Date Rough-in inspection required? ❑ Yes
� ❑ No Inspection Other Than Rough-In: ❑ Ready Now Will Call
� =� �p (You musf call the inspector when ready) Date Ready:
I, licensed contractor ❑ owner hereby request inspection of the above electrica) work at:
Job Address (Sheef, Box, or Roufe No.) City Zip Code
� � �r � ►� � e �/
Section No. Township Name or No. Range No. Fire No. Couny ^� 6��
Y �.
Occupanf �� � �
Power Supplier � � �
Electrical Conhactrr,JG�nq�y, � �.
Ni11CS CI.
� � � ��
Mailing Address (Con� r or Ownerperformin�
� � •
'0'�
Phone No.
Lic. No. �Plant Elect. Only)
I Authorized SignprGre (Conhactoy6r OwneF�rl��llll� Installation� � Cj X # I Phone No.
L�� _c lJ
EB-00001 A-1 1 8/96 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY .�-- - -'�""�`"