P - 83114REGtUEST FOR EIECTRICAL INSPECTION
- G 1��, /1 Z/1 Minnesota State Board of Electricity '�
� i�' �� 1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800 "�'
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industriai Farm Remod Re air
Air Co Htg. Equip. Water Htr. Load Ivigmt. Other.
Dryer Range Elec. Heat Temp. Service
"X" abave the work covered by this �equ�st. Enter remarks in this space and on the back of the white copy only.
L �` Y/l.�
�
Calculate Inspection Fee - This Inspection Request will not be accepted without fhe correct fee:
Other Fee # Service Entrance Size Fee # Circu+ts/Feeders Fee
Mobile Home Park Stail 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLV TOTAL���
Sign/Outline Ltg. Xfmr.
Alarm/Remote Conhol
Sw+mming Pool
I hereb certi ihaf I ins the elechical installafion described�herein on the dates stated
Irrigation Boom Rough-In Da�
Special Inspectio
Fi,wl D ��,
Investigative Fee 2.a�
THIS INSTALLATION MAY BE ORDERED DISCOP(NECTED iF NOT COMPLETED WITHIN i8 MONTHS.
i - ---
OFFICE USE ONLY This requesf void 18 months from validation date printed in fhis box.
II� I� III II I�I I� III �� (
�IIII�I��II� • . a
��1� s�
* 0 6 1 3 4 7 4 6* /5��
PLEASE PRINT OR TYPE
Requesf fe Rou h-in ins
�/i� 9 pecfioo required$ ❑ Yes ❑ No Inspection Other Than Rough-In: Ready Now ❑ Will Call
� ou musf call the ins �
� pector when readyJ pa� R� :
I, licensed contractor ❑ owner hereby request inspection of the above electrical work at:
lo Address (Sheet, x, or Roufe No.)
r -5 , �i, --, � L .. , �- c'%. // z�a c«k /
�$ecfion No. � Township Name or
0
tlechical Confractor (Company Name)
DEPENDABLE ELEC►�IC, INC.
dr Q�'Q�k $� rv ' imi fallc
C�on Rapida. MN 5�t433
or
Range No. Fire No. C y
�
Phone No.
� � �O�`3
.add�au
Conha�r License No. Master Lic. No. �Planf
., . _
1 8/96 �-- S gpARD COPY - SEE INSTRUC710NS ON BACK.QF YELLOW COPY