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1 Licensed Electrical Contractor 1 hereby request inspection ot above
Owner elec[rical work installed at:
52reet Address, Box or Route N-o.
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ecUOi? o. Townshlp ame or No. R?nge No. CounC
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Ocqupnnt (PRINT)
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Power SuDplier Address
Electrical Contractor (ComDany Name) CoMractor's License No.
Real. 646MX.Qsa oDo s 3 o
Mailing AddIress (Contractor or Owner Making Instaila/tion)
Authorized Signaiure (Contractor/Owner Making Installation) Phone Number
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MINNESOTA S T BOAflD OF ELECTNICITY THIS INSPECTION REQUEST WILL NOT
Griggs-Midwey Idg. - Room N-191 BE ACCEPTED BV THE STATE BOAN?
1821 Universitv Ave.. St. Paul, MN 55104 UNLESS PROPER INSPECTION FEE IS
Phone (612) 642-OSOO ENCLOSED.
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REQUEST FOR ELECTRICAL INSPECTION
, See insiructions tor compleling ihis form on 6aCk ot VelloW cOPy.
"X" Below Wark Covered by This Request
. Ell-
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v
New4Add Hep. Typa ot Building Appliancea Wired Equipment Wired
Home Range Temporary Servic
Duplex Water Heater Liyhtiny Fixtures
ApL Building Dryer Electrie Heatin
Commercial Bldy. Fumace Silo Unloader
Industrial Bldg. Air Conditioner Bulk Milk Tenk
Farm Other per.ify Olher(SUerify)
` Mer Syeci(y Qther Oiher
(.ompute lnspeCtion hee 8elow
p ; Fee SBrviceEntrence Size # Fee Fexders/SuAteeders k Fee Circuits
0 to200Am s 0 to30Am s 0 to 30Am s t
Above 200 qmps 37 to 100 Amps 31 to 100 A 5
. Swimming Pool Above 100_Amps Above 100_Amps
Transformers Irrigation Booms PartiaL'Other Fee
Signs Special Inspection
Remarks
n _. ..... Ar_. ,> 14 TOTAL F
CJi
Rough-in Date
1.the Electn
Inspector, here6y
t
l
Final Date-. car
i
y thet the above
spection hes been
p made.
mla reVuest vold 18 monihs irom
?/1,>201,y 7
.. . 7 116 2 '91 41 ?
Request Dale
4 Fire Nb. Rough-m Inspectron
Required?
? Heady Now >Will Notify Inspector
When R
d
?
pop ]gYes ? No ea
y
r%licensed contractor ? owner hereby request inspection of above electrical work at:
Job Address (Street, Bm or Route No.)
3 31
So Ciry
Sectlon No. Township Name or No. Rarga No. Coun
Occupan?R?T? ? A t ??
? ? PhoneNO.
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Power S{upNer J
I Address
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o Gr,.; . ,
Electrical Contreclor (Company Name)
6
4 ? Contrador§ License No. -
olq / 6 J
rRA2 k
Mailing Atldress (Contractor o1 Owner Making Installatfon)
S S t 94,
L??u rl/i:L
Authorizetl Signature (Contr. Owner Making s lation)
' . ,
V Phone Number
?s-.?- 6 3 U
MINNESO7A STATE BOARD OF BLfN;TRIqTY ? THIS INSPECTION REQUEST WILL NOT
Grlggs-Mitlway Bltlg. - Room 3-173 BE ACCEPTED BY THE STA7E eOARD
1821 Universlty Ave., St. Paul, MN 55104 UNIESS PROPER INSPECTION FEE IS
Phone (612) 842-0800 ENCLOSED.
REQUEST FOR ELECTRICAL INSPECTION M ee-00001-07
10- See insiructions for completing this form on hack of yenow copy. wd/6-,r7
7116 2 X° Befow Work Covered by This Request
e Add Rep. Type of Building AppliancesWired EquipmentWired
Home Range Temporary Service
Duplex Water Heater Electric Heating
Apt. Building Dryer Oiher (Specity)
Comm./Industrial Furnace
Farm ? Air Conditioner
Other (specify) CoMrector's Remarks:
Compute Inspection Fee Below:
# Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Swimming Pool
0 to 200 Amps
vir-
-
0 to 100 Amps
- ZOO
Transformers Above 200 _ Amps 7 Amp§
SlgfiS Inspector5 Use Only: TOTAL
Irrigation Booms I /
so
Special Inspection .
Alarm/Communication
Other Fee ,sd r
I, the Electrical Inspecbr, hereby
if
h Rough-in Date ??
cert
y that t
e above inspection has
been made. Final a_
>
OFFICE USE ONLY
This request void 18 monihs irom
n
0 078 704 4 1/.?/( ,?/V1.1;,?.?.
Request Date
Ol' 0???? F e No. Rough-In Insp tion Required
(You m
ust call inspector v en ready) Inspection Other Than Rough-In
Now ? Will Notity Inspector
? Read
?
Ves No ?
Date Read
IX licensed contractor ? owner hereby request inspection of above electrical work at
Job Address (Sireet, 6ox of Route No.)
3Bio G?G r.,?(? 7v4 City
e%47A^1
Section No. 7ownship Name or No. Range No. County
y?
OccHLZi7N/?/S jHf//G/?'N N?lLY? Phone 7??y???0
? ?
Power Supplier
4007"? a6o?ZG Address
0,E'.M/NG ?f).l
Electrical Contraaor (Company Name)
kr? 4on?sP2ucy1o^1 Contractor's License No.
Mailin Address (Conirector or Owner MaMng Installalion)
J?J3 6Jju-44As$?l,Q< ?1,2i/tr BVien?s?/iu.b .yn! ,SS`3ob ?
Aulhoriz ignaWre (Conlract ' wn Making Installation) Phone Number
,
MINWSOTA
(672) 642 00 OARD OF ELECTRICITV I?11 ?THIS INSPECTION REQUEST WILL NOT
Griggs-Mitlway Bldg. - Room S•728 BE ACCEPTED BY 7HE STATE BOARD
1821 Universlty Ave., St. Paul, MN 55704 UNLESS PROPER INSPECTION FEE IS
ENCLOSED.
REQILEST FOR ELECTRICAL INSPECTION ea-oooo/i-os
jl? See mstructions for completing this brm on tiack oEyellow copy.
0 0-7 !8 704 "X" Below Work Covered 6y This Request
Ne Add Rep: Type oi Building -Appliances Wired Equipment Wired
Home Range Temporary Service
Duplex Water Heater Electric Heating
Apt. Building Dryer Load Management
Comm./Industrial Furnace Other (Specify)
Farm Air Conditioner Z/ r/pJC
(sggr?'tyy
lCLM Contrar.tor•s Remarks. /.Iw,?? i/I Ax?W .fc7
Bsl
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u
%n'
*
?
Compute Inspection Fee Below: ? -
rs
x
yve
QO'fJQO X,lr . f??Jm ?????yfA jiWvje. L
# Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Swimming Pool 0 to 200 Amps 1 0 0 to 100 Amp . O. 110
Transformers Above 200 Amps Above 100 _Amps
SI nS Inspector's Use Onty: ? TOT L
Irrigation Booms ?
Special Inspection
Alarm/Communication THIS INSTALLATION MAY BE O DISCONNECTED IF NOT
Other Feesj' S • fb COMPLETED WI7HIN 18 MONTHS.
I, the Electrical Inspector, hereby
tif
h
h
i Rough-in oace
y t
cer
at t
e above
nspection has
been made. F;nai oa e /?
Y
OFFICE USE ONLY
This request void 18 months from
-r0?/O O
7113 5 i,
9oa?5
Fequest Date
/ f7 .?7/'? ^ t?'S? .
c
O[
. C3 S
l Fre No. Rough-in Inspec[ion
Required?
? Ready Now?Vill Notify Inspector
Wh
d
?
p
L
. Yes ? No en Rea
Y
I)?licensed contractor ? owner hereby request inspection of above electrical work at:
Joh Address (Street, Box qr Route No.J
'
3 8
4 City
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I? l.- e,
0S 4
GZ GC,iq
Section No. Township Name or No. Range No.
'J
Counry 1:?Z_?
Occupanl (PRINn
/
S
-I Phone No.
DI
V+' !JIC.°"
S
Power lier J
k Address
?'1 1 %51. Gu.
Elechical Contractor (Company Name
& Conhador§ License No.
Mailing Address (Conirador or Owner Making Instali tion)
Aulhorized g2%uia ( tracloVOwner Making Ilation) Phone Number
MINNESOTA SfATE 1300419 OF ELECTlSICITY
Grigga-Mitlway Bldg. - Rnom 5-173
1821 University Ave., St Paul, MN 55104
Phone (612) 642-0800
THIS INSPECTION REQUEST WILL NOT
BE ACCEPTED BY THE STATE BOARD
UNLESS PROPER INSPECTION FEE IS
ENCLOSED.
/•q/?. /??? REQUEST FOR ELECTRICAL INSPECTION eaooom-o?`
?J ip. See instructions for completing lhis form on back of yellow copy.
9oa ?''S
7113 5 "X" Below Work Covered by This Request
ew Add Rep. TypeofBuildiag AppliancesWired Equipmentwred
Home Range Temporary Service
Duplex Water Heater Electric Hea[ing
Apt. Building Dryer Other (Specify)
Comm.Mdustrial Furnace
Farm Air Conditioner
Other (specity) Contracto05 Remarks:
Compute lnspection Fee Be%w:
# Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Swimming Pool 0 to 200 Amps 0 to 700 Amps
TfanSfOrmers AbOVe 200 _ AmpS Above 100 _ Amps
SIgf15 Inspectoi5 Use Onty: TOTAL
Irrigation Booms
Special Inspection
Alarm/Communication
Other Fee
I, the Electrical Inspector, hereby Rough-in oam
certity that the a6ove inspection has
been made. Final a+e
d
OFFICE USE ONLY
This request void 18 months 1rom