P - 79512�02-3?5 �
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' Commercial
Air Cond.
Dryer
"X" above the v
REQUEST FOR ELECTRICAL WSPECTION
Minnesota State Board of Electricity 3
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone(612) 642-0800 "�'
Apt. Bldg. Other: New Addn
Farm Remod e air
Water Htr. Load Mgmt. Other:
Elec. Heat Temp. Service
request. Enter remarks in this space and on the back of the white copy only.
Calculate Inspec►ion Fee - This InspectionlQP,� be accepted without fhe correct fee:
Other Fee # Servi Entranc 'z Fee # Circuits(Feeders Fee
Mobile Home Park Stall 0 t 20' m � 0 to 100 Amps
Street Ltg./Traffic Sig. Above`200 Am s Above 100 Amps
Transformerf Generator INSPECTOR'S USE ONtY TO��/' `�
Sign/Outline Ltg. Xfmr. '�
Alarm/Remote Control
Swimming Pool
I hereb certi thaf I ins the elechical installation described herein on fhe dates sfafed
Irrigation Boom Roo9h-in Dar�
Special Inspection
Imestigative Fee Final � r �
�
THIS INSTALLATION MAY BE ORDERED DISC ECTED IF NOT COMPLETED WITHIN 18 MONFHS.
OFFICE USE ONLY 1}�is request void 18 monlhs from validation dote printed in this box.
I IIII II III II III II III II �I� II lIl II III II �II II I� I I�I o
* 0 8 0 2 3 2 5], * �r ���
PLEASE PRINT OR TYPE
R ues Dafe Rough-in inspeciion required2 es No InspecTion OlFier Than Rough-In: ❑ Ready Now WiN Calf
�� J� � �You must cali the inspecror wh ready) Date Ready:
I, ❑ licensed contractor ❑ owner hereby request inspection of the above elechical work at:
Job Address (Sheet, Box, or Route No.) Cily Zip Code
1� � St�,. b� �, �� �s�l3a
Secfion No. Townshio Nam or N� anae No. . fire No. C fv
`� �� 29
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Power Supplier
Elechical Conha mpany Name)
L.�''!"� �L-� "'�
Mailing Address (Conh or Owner Performing
�
A ' J Signafure �Con r Owner P ri
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IB00001 A-11 6/96 STATE BOA
Phone No.
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LS olu� �t ��s �a�
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- SEE INSTRUCTIONS ON BACK OF YELLOW COPY