P - 826574,��-911
Commercial
Air Con�d:�`
"X" above the work
RE(�UEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104 �
Phone(612)642-0800 "�'
Other: New Addn
Farm
Water Htr. Load Mgmt. Other:
Elec. Heat Temp. Service
request. Enter remarks in this space and on
of the 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 200 Amps � 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY T03AL �
r,,../n.,+l,.,o i+., xFm� A %5
Alarm/Remote Control
Swimming Pool —
I hereb certi thaf I ins fed the elechical installation dexribed her q on fhe es a d"
Irrigation Boom RougMn •,�n� � D��t,.-L3 G
Special Inspec' N► F��a� � � �a �
,-� _,_ _�< _— ��+ -_
Investigative fee � '
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLET�D WITHIN 18 MONTHS.
OFFlCE USE ONLY This request void 18 monfhs from validation date printed in fhis box.
I IIII II I�I II ill II III II II I Ir II I I III II III I IIII
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* O 4 O O 9 L 1 4* PLEASE PRINT OR TYPE
Requesf Date Rou h-in ins tion r uired? es ❑ Read Now � Will Call
g pec eq ❑ No Inspecfion Ofher Than Rough-In: y
� �You must call the inspector when ready) Date Ready:
I, censed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address �Sfreet, Box, or Route No.) � City • Zip Code
�35 � �'2t:�.,�r � nc�L.�
Section No. Township Name or No. Range No. Fire No. C nty
/�/1.J0
OccuoABf Phone No.
Mailing
Confracfor License No. � Masfer Lic. No.
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P ri
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ia yr�i for yP/�fgry�g Installation)
STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY