P - 81532�, REQUEST FOR ELECTRICAL INSPECTION - �
5'�,� - 5 6 3 Minnesota State Board of Electricity
� %� 1821 University Ave., Rm. S-128, St. Paul, MN 55104
, _ _- .
-- ` Phone(612)642-0800 �
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Home Duplex Apt. Bidg. Other: �� New Addn
Commercial Indushial Farm / S Remod Re ir
Air Cond. Htg. E uip. Water Hfr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service ��
"X" above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
Calculate Inspection Fee - This Inspection Request will noi be accepied wiihoui the correct fee:
Other Fee # Service Entrance Size Fee # ..-6ircuits
Mobile Home Park Stall 0 to 200 Amps 0 ro 100 A
Sheet Ltg./Traffic Sig. Above 200 Am s Above l OQ
Transformer/Generator INSPECTOR'S USE ONLY
Sign/Oudine Ltg. Xfmr. /%ss�.(� �1}�
i -
Alarm/Remote Conhol
Swimming Pool �(�//�-
I hereb certi that I ins the eleclrical installafion described herein
Irri�ation Boom v,.,��,,.. �-, _
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THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COIIPLETED WITHIN 18 MONTHS.
/1 OFFICE USE ONLY This requesf wid 18 months (rom validation date printed in this box.
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PLEASE PRINT OR TYPE
R�1'�u �O� R h-in ins on r uired2 Yes
J «g pecli eq ❑ No Inspeclion OII� Than RougMn: ❑ Ready Now wll Call
�"( �/g (You musf call the inspecior when ready) Date Ready:
I, ❑ licensed conhactor �owner hereby request inspection of the above elecfricol work at:
Job Addreu �Sheef, Box, w Rouae No.) Ciy Zip Code
� .�' S�� yVC � �`ai�e ��'�3�-
$ecfion No. Township ame r No. Range No. Fire No. County
�O �`f �HA /G'�
7�
Name�
Phone No.
K� e i it c/� ��/L —
No.
�'G � 7 7
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AAaster Lic. No. �Plan
dress (Conhac�or w Owner Perfurming Installation)
' � S'� � N/E : �C e /1/ �
SignaNre (C ha or er P ing Installafion) p�p� �.
� . 2 �� .�� �
11 8/96 p7� BOARD COPY - SEE INSTRUC710NS ON BAC F YELLOW COPV