P - 82141REQUEST FOR ELECTRICAL INSPECTION ��
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� � � � � � (� � � � Minnesota State Board of Electrici#y �;
� a 1821 Universiry Avenue Suite S-128, Saint Paul, Minnesota 55104-2993
r � (651) 642-0800 www.electricity.state.mn.us "���
j Home Duplex Apt Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air C er Htg. Equip. Water Hfr. Load Mgmt. Other.
Dryer Range Elec. Heat Temp. Service
"X" bove ihe work covered by this 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 accepted without ihe correct fee:
Other Insfallations Fee # Service Enfrance 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 TO��T-Ay,,,D�
Sign / Outline Ltg. Xfmr, t/!
Alarm/Remote Control
Swimming Pool
I hereb certi fhat I ins ted the electrical installation described herein on fhe dates stated:
Irrigation Boom Ro�9h-io �are
Special Inspech • �
Final Dafe
Investigative Fee =�.__ G� '`�-�Q
THIS INSTALLATION MAY BE ORDERED DISC CTED IF NOT COMPLETED WITHIN 18 MONTHS.
� OFFICE USE ONLY This request void 18 monihs from validation date prinfed� in this box. �
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* 0 9 5 0 0 2 0 8� a���
PLEASE PRINT OR TYPE
Requesf Dafe Rough-in inspection required? ❑ Yes ❑ No Inspection Ofher Than Rough-In: Ready Now � Will Call
``� °� You musf call the inspec}or when ready Da}e Ready: �
I, licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
Jo Address �Street, �B -� te No.� City � Zip Code
�/�_ � / :/-� �i Oi�Iiyl p.�, , .S'S'�%3a
� Power
or No. � Range No. � Fire No.
PENDABLE ELECTRIC C `.
irt RapiEs. M�� Bhr 33 ��� �
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Signature (Confr , ompany or pw�ec.E�rformin� Ins Ilation�
Phone No.
1
License No.
�� 31 lS / S�7U'
SEE INSTRUCTIONS ON BACK OF YELLOW COPY