P - 80411RE(�UEST FOR ELECTRICAL WSPECTION �
�'� �� Q(a Q Minnesota State Board of Electricity
. v`� �� 1821 University Ave., Rm. S-128, St. Paul, MN 55104
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Phone(612)642-0800
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Re ir
Air Cond. Htg. Equip. Water Hh. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work c vered by this request. Ente remae rk�ln this,space an on the back of the white copy only.
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Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # Service Entra Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 00 Am 0 ro 100 Amps /��
Sfreet Ltg./Troffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL (�.J.�
Sign/Oudine Ltg. Xfmr. ♦ �1 V
Alarm/Remote Control
Swimming Pool
I hereb ceAi that I ins the eleclrical installation described herein on Ihe dales sFORed
Irrigation Boom Roogh-In Doie
Special Ins
Finot DaA�/ '���
Investigqtive e O��
THIS INSTALLATION MAY BE ORDERED dSCONN CTED IF NOT COMPLETED NIITHIN 18 MONTHS.
OFFICE USE ONLY This requast void 18 monlhs kom ��le�-� lhis box.
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PLEASE PRINT OR TYPE
R � �°�e Rough-in inspecfion required$ ❑ Yes ❑ No Inspeclion Other Than RougMn: e�dy �
e9�e�/� ❑R Now WiIlColl
r2 � Q"D (You must call the inspecror when reody) Date Ready:
I, �licensed controctor ❑ owner hereby request inspection of the above electrical work at:
Job Address �Sheet, Box, w Route No.) Zip Code
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Seclion No. Township Name a Range No. Fire No. C nty
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Occupanf Phone No.
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Elechical Contracto� (Compan Name) Conhactor License No. Master lic. No. (Plant Elec1. Ooly)
N vt,� 1'� i�i�,v s� oaS J�uc. C �9 o z�
Mailing Addrau (Con �� rmi� Insla� on� � � �
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AWh alure (Conhactw or er Pe Installation) f Phone No.
, GS�-�8� /49�
E 1 A-11 8/96 STATE 60ARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY