P - 80838, REQUEST FOR ELECTRICAL INSRECTION
8 � � � � � � � Minnesota State Board of �lectnciry
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800 '�'
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Re air
Air Cond. Htg. Equip. Water Htr. Lood Mgmt. Other:
Dryer Range Elec. Heaf 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 withou► the correci fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps �
Sfreet Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY T0�1L
Sign/Outline Lig. Xfmr. j�dO�Or f0
Alarm/Remote Conhol
Swimming Pool
I hereb certi that 1 ins ted the elechical insMllation dexribed herein on the dates stated
Irrigation Boom Rougf�ln oare
Special'In
Investigafi F� ��2-'� � 'd�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validation date prinfed in this box.
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PLEASE PRINT OR TYPE
Request Date Rough-in inspection requiredZ ❑ Yes No Inspection O�er Than Rough-In: eady Now � Will Call
� 3'�� �You must call the inspecfor when ready) Date Ready: J/ ,,,3
I, licensed conhactor ❑ owner hereby request inspection of the above electrical work at:
Job Address �Sheeo. Box, or RouAe No.� � {";-�, � Zip Code
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Secfion No. Township Name or No. Range No. Fire No. ounty
hokQ,
Occupant Phone No.
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Power upplier Address
Elechical Confractor �Company Name� ' Conhactor License No. Masfer Lic. No. �Plant Elecl. Only)
s�/ LecTQ�c �c C�oo/
Mailing Addres (Conhactor or Owner PerForming Installation�
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Aufh 'z i ture �Conhacfor or Owner Performin nstallafion) I Phone No. �
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E -i l 8/96 �p� g0 COPY - SEE INSTRUL`TIONS ON BACK OF YELLOW COPY