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P - 79512�02-3?5 � r ' 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 � Power Supplier Elechical Conha mpany Name) L.�''!"� �L-� "'� Mailing Address (Conh or Owner Performing � A ' J Signafure �Con r Owner P ri �_ IB00001 A-11 6/96 STATE BOA Phone No. ��3- S� �i - ���,d LS olu� �t ��s �a� � 17�3 5� - SEE INSTRUCTIONS ON BACK OF YELLOW COPY