P - 82954REQUEST FOR ELECTRICAL INSPECTION -
��F �°� 5 4 7 Minnesota State Board of Electricity
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 e air
ir Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered b this request. Enter remarks in this space and on ►he back of the white copy only.
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Calculafe Inspection Fee - This Inspection Requesf will not be accepted withouf the correcf fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps % 0 to 100 Amps . Q�
Street Ltg./Traffic Si9. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL/ ��
Sign/Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
I her certi that 1 ins the elechical installation described herein on the dates staled
Irrigation Boom RouyMo Dare
Specia! Inspecti
Investigative Fee F��� �O p � 3�-6�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
��I f� III tl III �� I�� I� � OFFICE USE ONLY This request void 18 monihs from validafion date prinfed in fhis box.
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* 0 6 4 7 5 4 7 9* �
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PLEASE PRINT OR TYPE
Request Dafe Rough-in inspection r uired?
v� �'� eq ❑ Yes . Inspection Other Than RougMn: Now ❑ Will Call
(You musf call the inspecfor when ready) Date Ready:
I, licensed conhactor ❑ owner hereby request inspection of the above electrical work at:
1ob Address �Skeef, Box, or Route No.) City Zip Code
Y/ �
Secfion No. Township Name or No. Range No. Fire No. Cou
a� � �'' ` Phone No. � �
V � � —
Power upplier Address
Elechical Confractor �Company Nome� Contracfor License No. Masfer Lic. No. ,Mant Elecf. Onl�
Harrison Electric Inc. CA0080$
Mailing Address �Conkacfor or Owner Performing Insfallation�
25 5 Neva u North, , Golden Valley 55427
Aufho a r nha or r ming Ins f � Phone No. �
� 544-3300
E��O 8�96 ATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YEILOW COPY