P - 83993REGIUEST FOR ELECTRICAL INSPECTION
� � � � �} � � � Minnesota State Board of Electricity
J 1821 University Ave., Rm. S-128, St. Paul, MN 55104
r Phone(612)642-0800
Home Duplex Apt. Bldg. Other: New Addn
Commercial I ustrial Farm Remod e air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Terr�p. Service
"X" above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
` � "� � y��l
Calculate Inspection Fee - This Inspection Request will not be accepted without the correc! fee:
Other Fee # Service 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 INSPECTOR'S USE ONLY TOTAL _
Sign/Outline Ltg. Xfmr. �� �
Alarm/Remote Control
Swimming Pool
I hereb certi that I ins ected ihe electrical insfallation described herein on fhe dates sPated
Irrigation Boom Rough-In ��
SD2CIOI If15p2CfIOfP1 }� ,�f � _ . . . � .. _
Fee
��....
Investigative Fee _- � _ _- �-_--_ . ' _`- —
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requesf void 1 S months (rom validaTion date printed in this box.
. �—���/
I IIII II III II III II III II III I I(I III II III I IIII �C./e7C ! Q
�K � 5 5 � 3 0 7 3* LEASE PRINT OR TYPE f� 'v�'
Requesf Date Rough-in inspection required? ❑ Yes o Inspection Oiher Than RougMn Recdy Now � W�II Call
1 �O% (You musi call fhe inspector when ready) Dafe Ready:
�
I, licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
� :.� 3 �iz �"r �' � : - � i�'l�'�
Section No. Township Name or No. ange No. Fire No. ounty/j
YT/%/%/� G��1
Occupanf
Power
Elechical CoMracbr (Company Name�
Harrison Electric, Inc
Mailing Address �Contractor or Owner Performi�g Installation)
�
Phone No.
License No. Masfer Lic. No.
� M J n
�1
IS ON BACK OF YELLOW COPY
No.