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REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993
(651) 642-0800 www.electricity.state.mn.us
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Wafer Htr. Load Mgmt.
Elec. Heat Temp. Service
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"X" above the work covered by this request. Enter remarks in ihis space and on the back of the white copy only.
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Calculote Inspection Fee - This Inspecfion Request will not be accepted without the correct fee:
Other Installations Fee # Service Enirance Size Fee # Circuifs / Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg. / Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
Sign / Outline Ltg. Xfmr. ��
Alarm/Remote Control
Swimming Pool
I hereb cerfi fhat I ins ected fhe electrical installafion described herein on the dafes stated:
Irrigation Boom Rough-In Date
Special Inspection
9 Final ��` pa'O � � A d
Investi ative Fee �°
_ THIS INSTALLATION MAY BE ORDERED DISCO ECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 monfhs from validation date printed in fhis box.
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PLEASE PRINT OR TYPE
Request Date Rough-in inspection required? ❑ Yes
V� ^ ❑ No Inspecfion Ofher Than Rough-In: eady Now ❑ Will Call
�� - v You must call the inspecfor when ready Date Ready:
I, �licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.� City Zip Code
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Section No. Township Name or No. Range No. Fire No. Cou
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Power Supplier
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Phone No.
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Confractor License No. Master Lic. No. �Plant Elect Only)
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Phone Number
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SEE INSTRUCTIONS ON BACK OF VE��ow rnav