P - 83851REQUEST FOR ELECTRICAL INSPECTION -
5 2 C? 3• 7� J Minnesota State Board of Electricic�
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
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other: •
Dryer Range Elec. Heat Temp. Service
„X„ above the work covered by ihis request Enter remarks in this space and on the back of the white copy only.
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Calculaie Inspection Fee - This Inspection Request will not be accepied without the correcf fee:
Other Fee #$ervice Entrance Size Fee Circuits/Feeders
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps --
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTpR'S USE ONLY TOTAI,�
Sign/Outline Ltg. Xfmr. /
Alarm/Remote Conhol
Swimming Pool
I hereb certi that I ins ected the eleckical installation dexribed herein on the dates stated
Irriqation Boom o_.._� �_
Imestigative Fee N f; F�^al '
. 2
THIS INSTALLATION MAY BE ORDERED DISC __ _CTED IF NOT COMPLETED WITHIN 18 MONT S.
OFFlCE USE ONLY This requesf void 18 months from validation date prinfr.d in fhis box.
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* � 5 2 6 7�% 5�'4c PLEASE PRINT OR TYPE 15�J�
Request D Rough-in inspection required2 ❑ Yes o Inspection Other Than Rough-In: ead Now
�j� �� Y ❑ Will Call
�/ (You must call the inspector when ready) Date Ready:
I, licensed contractor ❑ owner hereby request inspection of the above electrical work at:
I Address (Sfreet, Box, or Route No.) Ci�� �� Zip Code
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Secfion No. Township Name or No. Range No. Fire No. Coushr
Power Supplier
lechical Confractor (Company Name) Conhacfor License
Harrison Electric, Inc. CAO 808
hailing Ad s �Contractor or Owner Perfo�ming Installation)
Phone No.
�� r
Master Lic. No. (Plant Elecf. Only�
252 N vada Ave rth, 301 Golden Valley 55427
Authoriz e do Own e in Innsta Y n) Phone No.
i �
v� 2 � J �'�� 54�-3300
EB-OOOOI A-11 8/96
l STAT BOARD COPY - SEE INSTRUC770NS ON BACK OF YELLO�'l/ COPY