P - 82523����-234 �
� Home Duplex
Commercial Industrial
Air Cond. Htg. Equ
Dryer Range
"X" above the work covered 6
REQUEST FOR ELECTRICAL INSPECTION °'E
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104 �
Phone (612) 642 Ov,
j, .
Apt. Bldg. Other: �� �' New Addn
Farm Remod Re air
Water Htr. Load Mgmt. Other:
Elec. Heat Temp. Service
request. Enter remarks in this space and on rhe back of the white copy only.
Calculate Inspection Fee - This Inspection Requesf will r,ot be accepted wiihout fhe correct fee:
Other Fee # Service Entrance Size Fee Circuits/Feeders
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Sfreet Ltg./Traffic Sig. Above 200 Am s Above 100 Ar
Transformer/Generator INSPECTOR'S USE ONLY TOT
Fee
$ign/Oudine Ltg. Xfmr. L, `� ~� (.. J 0
Alarm/Remote Control
Swimming Pool �� — %C%^.2 �_ d�
I hereb certi that I ins the eleciri Ilation dexri ein on the dates slafed
Irri9ation B . Rough-In
Special Inspec io �'Z �
Final . /
Investigative Fee ��-3� --E'Jl
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
. OFFICE USE ONLY This request void 18 monihs from validafion dafe printed in this box.
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* 0 8 0 2 2 3 4 5* �%�d
PLEASE PRINT OR TYPE
Requesf Dafe Rou h-in ins on r uired? Yes
g pecti eq ❑ No Inspecfion Olher Than RougMn: ❑ Ready Now Will Call
�`` 3" �You must call the inspecfor when ready� Date Ready:
I, ❑ licensed conhactor � owner hereby request inspection of the above elechical work at:
� Job Address (Sheef, Box, or Roufe No.) City Zip Code
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Seclion No. Township Name or No. Ranae No. Fire No_ C��nw
Mailing
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�Company Nome) '- � � V
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nhactor or Owner Performiog Insfallafion)
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IPhone No.
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Conhacror License No. Maste
Phone
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BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY