P - 83156, `� RE(�UES7 FOR ELECTRICAL INSPECTION
C�� C� C O� Minnesota State Board of Electricity
C;% U �� 1821 University Ave., Rm. S-128, St. Paul, MN 55104
_Phone (C�12) 642-0800
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Re air
Air Cond� Htg. Equip. Water Htr. Load M mt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above ►he work covered by ihis request. Enter remarks in this space and on the back of the white copy only.
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Calculafe Inspection Fee - This Inspection Request will not be accepted without ihe correcf fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders ee
Mobile Home Park $ta41 0 to 200 Amps 0 to 100 Amps
Sheet Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL.
Sign/Outline Ltg. Xfmr. ����
AlarmjRemoFe Control
Swimming Pool
I hereb certi that I ins the electrical installafion described herein on the dates stated
Irrigation Boom RougM� Dor�
Special Inspec
�Find Dore. � ` .— Z,— c
Investigative Fee L (
THIS 1NSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFRCE USE ONLY This request void 18 monfhs from validation date rinted in�s j�x.
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PLEASE PRINT OR TYPE —`
Requesf Do � Rough-in inspeclio� tequired? ❑ Yes ❑ No lnspeclion Ofher Than RougMn: eady Now � WiN Call
��a(� �(You must call the inspedor when ready) Dafe Ready:
I, licensed contractor ❑ owner hereby request inspection of the above electrical work at:
1ob Address (Sheef, Box, r Route No.) Cily Zip Code
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Seclion No. Township Name or No. Range No. Fire No. Cou
O/`/'
Occupanf Phone No.
5"�/-303�
Power Supplier /� /� Address � �
Y�
Elechical Contraclor (Company Name) �. Conh License No. Master lic. No. (Plant Elect. Only)
DEPENDABLE ELECTRI�• �K�• Do?G..��J %1C�C�3
�kQj�. ��g �5rollanoo)
C�on Rap+ds, MN 5543
Aufhorized $ignaNre �Conha ner Performiig s Ilalion) +� ' Phone No.
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EB-00001 8/96 STAT ARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY