P - 80820REQUEST FOR ELECTRICAL INSPECTION
8����� Q � Minnesota State Board of Electricity
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`� 1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800
Home Dupfex Apt. Bldg. Other: New Addn
ommercial Industrial Farm Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
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Calculate Inspechon Fee - This Inspection Requesi will not be accepted without fhe correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Sfreet Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL ��D
Sign/Outline Ltg. Xfmr.
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Alarm/Remote Control
Swimming Pool I herebvi certifv that I insoecled the elecfrical insfallafion described heiein on ihe dates stafed
Investigative Fee ����� —� %/ �l
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
- OFFICE USE ONLY 7his requesf void 18 months from validation date printed in ihis box.
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PLEASE PRINT OR TYPE
Request Date RougMin inspection required$ ❑ Yes ❑ No Inspeclion Olher Than RougMn: Ready Now ❑ Will Call
g' 3•�� (You must call the inspecFw when ready) Date Ready: �
I, icensed contractor ❑ owner hereby request inspection of the above electrical work ot:
Job ddreu Shcet, Box, or Route No. /�l Ci Zi Code_/
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Section No. Township Name or No. Range No. Fi�e No. Cou � �
Occupant /
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Power Supplier (' �
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ical Conhacfor �Company Name�
�PENDABLE ELECTRtC, I
oon Rap�ds. MN 55433
Authorized Signature �Confracfor o ner Perfori
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EBOOOOIA-11 8/96 S7ATE OA
Phone No.
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Contractor License No. Master Lic.
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- SEE INSTRUCTIONS ON BACK OF YELLOW