P - 84298� � � REGIUEST FOR ELECTRICAL INSPECTION �.
4 4 2- 2 g g 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 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. Enier remarks in this space and on the back of the white copy only.
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Ca{culate Inspection Fee - This Inspection Request will not 6e 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 ��
Street Ltg./TrafFic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
Sig�/Outline Ltg. Xfmr. ' . �
Alarm/Remote Control
Swimming Pool
I hereb certi that I ins ec}ed fhe electrical ins}allation described herein on fhe dafes sfated
Irrigation Boom ,� , Rouglrin pa�e
Special Inspectio =. � � `_a
Final - Oate
Investigative Fee ,.
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WIT N 18 MONTHS.
OFFlCE USE ONLY This request void 18 months from validation date prinfed in this box.
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PLEASE PRINT OR TYPE
Request Date Rou h-in ins tion re uired?
/_�OI ,7 �y g pec q ❑ Yes No Inspecfion Other Than Rough-In: Ready Now 0 Will Cal)
� � (You must call fhe inspector when ready) Date Ready:
I, �icensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (SMeet, Box, or Roufe No.� City Zip Code �I
`� A�uz Sz��,-r- Na� fi��-�.
Secfion No. Township Name or No. Range No. Fire No. CounN
vccupanr Phone No.
�c�yrtr� 57 �_
Power Supplier p,l,l,e«
il Co�hacfor (Company Name� � Coniracfor License No. Master Lic. No. (Plant Elecl. �
Harrison Electric, Inc. CA00808
Address (Conhactor or Owner Performing Installafion)
2525 Nevada Ave. N. #301, Golden Valley, MN, 55427
Si nature (Conh fo or e erforming n allatio [j� ^��y Phone No.
Pa�' � E: �� i�.,� 544-3300
� TATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY