P - 84421REQUEST FOR ELECTRICAL INSPECTION
< � See instructions for completing this form on back of yellow cOpy�
� 0 0 9 4 9 3 8 "X" Below Work Covered by This Request
� New Add Rep. Type of Building Appliances Wired
Home Range
Duplex Water Heater
Apt. Building Dryer
Comm./Industrial Furnace
Farm Air Conditioner
Other (specify) Conhactor's Remarks: /� �
;f.��n.�
Compute Inspection Fee Below: / ��`Fi�' �
# Other Fee # Service Entrance Size Fee #
Swimming Pool 0 to 200 Amps
Transformers Above 200 Amps
Signs Inspector's use Only
Irriqation Booms
��E�'�' EB-00001-09
�
��� 3
�S�
��ay�.�
nent Wired
Service
Electric
Load N
Other (
��/"1 f/ � / /`/ �J1(
J
Circuits/Feeders Fee
0 to 100 Amps
Above 100 Amps
Hiarmi�om nication THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT
Other Fee COMPLETED WITHIN 18 MONTHS.
I, the Electrical Inspector, h reby Rough-in Da/t�
certify that the above inspection has `� Z 2^��
been made. F'�ai �,_„y�__...� �t� � i
`
OFFICE USE ONLY
This request void 18 months from .
--------------------------_. .. ______. ..------------------------
�"'� `-�' 3 J '�� ."� `�� ��
�
Request Date Fire No. Rough-In Inspection Required Ins{,,,.,,ion Other Than Rough-In
(You must call inspector when ready) � Ready Now �Will Notify Inspector
� Yes ❑ No Date Ready
I�.licensed contractor ❑ owner hereby request inspection of above electrical work at:
Job Address (Street. Box or Route No.) City �
a-- �' � '
Section No. Township Name or No. Range No. County� ,
(Company Name)
Mailing Address (Coniractor or
�
i
Address
� � �,
�ation)
i � ._ �
Contractor's License No.
Phone Number
y. ,-71a ��������H�II��III���f � THIS INSPECTION REQUEST WI NLL pT
7827 Univers Ave., . aul, MN 55104
Phone (si2) 642-080o BE ACCEPTED BY THE STATE BOARD
UNLESS PROPER INSPECTION F
ENCLOSED.