P - 84483REQUEST FOR ELECTRICAL INSPECTION
4�F'L — 4 4 3 Minnesota State Board of Electriciiy
h 1821 University Ave., Rm. S-128, St. Paul, MN 55104 �:
Phone(612)642-0800
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Re oir
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 ihe back of the whiie copy only.
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Calculate Inspection Fee - This Inspection Request will noi be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps °O
Street Ltg./Traffic Sig. Above 200 Amps Above 100 Amps
Trons{ormer/Generafor INSPEC70R'S USE ONLY TOTAL _� �p
Sign/Oudine Lfg. Xfmr. �
Alarm/Remote Conhol
Swimming Pool
I hereb certi that I ins ted the elechical insfallafion described herein on fhe dafes stated
Irrigation Boom eo�yMo pa�
Imestigative Fee ; `� .�".� � ° �,C�„y-� - � � –'Z — "7
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITH N 18 MONTHS.
OFFICE USE ONLY This requesf void 18 monihs from volidation date prinfed in this box.
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* 0 4 4 2 4 4 3 8* �
EASE PRINT OR TYPE
Requesf Date Rough-in inspection required2 ❑ Yes No Inspec6on Olher Than Rough-In: Ready Now 0 Will Call
�� �' �jZ (You musf call the inspecfor when ready) Dafe Ready:
I, licensed conhactor ❑ owner hereby request inspection of the above electrical work at:
1ob Address (Sheet, Box, or Roufe No.) City � Zip Code
Sl�'� Sr� tr o.et� �A.t� ' �.�r�t
Section No. Township Name or No. Ranpe No. Fire No. C ntv
nr Pfwne No.
/louJC'f�•4L !K �"?l llZ ,
Power Supplier Address
Electrical Contractor (Company Name) Conhacfor License No. Master Lic.
Harrison Electric Inc. CA00808
Mailing Addreu (Confracfor or Owner PerForming insiallafion)
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COPY - SEE INSTRUCTION$ ON BACK OF YELLOW COPY