P - 80724,� REQUEST FOR ELECTRICAL INSPECTION
7$��� O 5 � Minnesota State Board of Electriciry '3
1821 University Ave., Rm. 5-128, St. Paul, MN 55104 -
Phone(612)642-0800
Home Duplex Apt. Bldg. Other: New Addn
ommercial Industrial Farm Remod Re air
Air Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this reqvest. Enter remarks in this space and on the back of ihe white copy oniy.
I �/� � ��-
Calculate Inspec►ion Fee - This Inspection Request will not accepted without the correci fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Pee
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 ON�Y TOTAL�
Sign/Oudine Ltg. Xfmr. !`��- G- `��
L� � ��iT
Alarm/Remote Conhol
$wimming Pool
I hereb certi that I ins the electrical insmllation described herein on the date stated
Irrigation Boom RougMn Dare
Special lnspecti �
Investigative Fee �" "' �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validation dare nrinted in thic F»x.
III� II III II III II I�1 �I �I� �I II�I �II � III I�1
* 0 7 8 6 6 0 5 6*
�`'' " S,
r'c� .3 ��
PLEASE PRINT OR TYPE
"�°"' """' Rough-in inspeclion requiredZ ❑ Yes ❑ No Inspeclion Olher Than RougMn: Ready Now � Will Call
�`�� ` Q� I �You must call the inspecYOr when ready� Date Ready:
I, licensed contractor ❑ owner hereby request inspection of the above electrical work at:
1 A reu �Sheef, Box, or Route No.� C�i '^ Zip
�CU � / � � n
Secfion No. Township Name or No. Ranae No. Fire No. Counw �.
Otcupan/
Power Supplier
/ V✓�
Eleckical Conhacbr �Company Name)
JEPENDABLE ELECTRIC, INC,
�il�d rt��jon 5hv r i nsta
Ceon Rapids, MN 55433
Authwized SipnaNre ICo r or Owner Performina
Phone No.
% o� r' ��% /
Contracror License No. Masfer Lic. No.
�� �._�� /l%lLl
:;�
�-�-� � ' � �s 7 ;S'4y0
STATE AR COPY - SEE INSTRUCiIONS ON BACK OF YELLOW COPY