P - 83878!� '
��50-184 �
REQUEST FOR ELECTRICAL INSPECTION
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
Commercial Industrial Farm Remod
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Ra�ge Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on �he back of the white copy c
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Calculaie Inspection Fee - This Inspection Request will not be accepted without the correct 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/Oufline Ltg. Xfmr. S
Alarm/Remote Control
Swimming Pool
I hereb certi fhat I ins cted the elecfrical installation described herein on the dates siafed
Irrigation Boom Rouqhan pa�
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Fee
Investigative Fee ��1 � R ������ . L C�- �
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THIS INSTALLATION MAY BE ORDERED DISCO CTED IF NOT COMPLETED W HIN 18 MONTHS.
OFFICE USE ONLY This requesf void 18 monfhs from validation dafe prinfed in IFiis box.
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PLEASE PRINT OR TYPE /5 �
Request Da Rou h-in ins tion r uired?
g pec eq ❑ Yes Inspection Other Than Rough-In: . Ready Now ❑ Will Call
U�� (You must call the inspector when ready) Date Ready:
I, ' licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address �Sheef, Box, or R te No.) Ciy Zip Code
lb�N �rtardolP Fi2r�C�
Section No. Township Name or No. Range No. Fire No. County N
Occupanf
lJ
Power Suppiier
Elechical Conhacfor (Company Name)
Harrison Electric, Inc. C
Mailing Address �Conhacto: or Owner Performing Installation)
2525�N vada A�n���r r,, 301,
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STATE
Phone
/ ^40�
:ontractor License No. I Masfer Lic. No. (Plai
08
3en Valley �54"7
Phone No.
� E� � � �� ? 544-3300
IONS ON BACK OF YELLOW COPY