P - 83249RE(IUEST FOR ELECTRICAL INSPECTION '�
6��� 3 5 5� Minnesota State Board of Electricity �4'
r � 1821 University Ave., Rm. S-128, St. Paul, MN 55104
. ° Phone (612) 642-0800 `'�°'
Home Duplex
Commercial Industrial
Air Cond. Htg. Equ
Dryer Range
"X" above the work covered 6
Farm
Wa�er Htr. Load Mgmt. Other:
Elec. Heat Temp. Service
requesf. Enter remarks in this sppce and on the back of fhe
New
copy
�b C��I,a,u.�o � ��� -����5
Calculate Inspection Fee - This Inspection Request will not be accepted without the correcf fee:
Other Fee # Service Entrance 5ize 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 ON�v TOTAI �
Sign/Outline Ltg. Xfmr. "�
Alarm/Remote Control
Swimming Pool
I hereb certi Ihaf I ins fhe elechical installa�ion described herein on the datas stated
Irrigation Boom Rough-In Dare
Special inspecli ',
�i�l
Investigative fee —'
THIS INSTALLATION MAY BE ORDERED DI TED !F NOT COMPLETED ITHIN 18 MONTHS.
.. OFRCE USE ONLY This request void 18 months from validation date printed in this box.
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PLEASE PRINT OR TYPE
Reques� Rough-in inspeMion requiredZ ❑ Yes o Inspecfion Other Than Rouglrin: ❑ Ready Now iA Call
�' `Q 'q (You must call the inspector when ready) Date Ready:
I, [�licensed contractor ❑ owner hereby request inspection of the above elechical work at:
Job;ddress ($ireef o or Route No.) Ciy ,,I Zip Code
O` U ���� q� w� �'Q � � 1 I lJ� �P.� 'rJ r'J�i � e�+
Secfion No. Township Name or
Occupant^ '� • � /
�� �j„i�.r y 1
Power $upplier
:al ConMacfor �Company Name�
� � �!►L � � �Ci.
�o�„�y
r� OI�Ca
Phone No.
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Conhactor License No. � Master Lic. No.
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'INSTqUCT10NS ON BACK OF YELLOW COPY