P - 81492REGIUEST FOR ELECTRICAL INSPECTION =
7���� C C . Minnesota State Board of Electricity
..J �� c) 1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone(612)642-0800
ome Duplex Apt. Bldg. Ofher: New Addn
1 Commercial Industrial Farm Remod '
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Ran e Elec. Heat � Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
Calculate In'spection Fee - This Inspe
Other Fee
Mobile Home Park Stall
Sfreer Lrg./Traffic Sig.
Tra nsformer/Generator
Sign/Oudine Ltg. XFmr.
Alarm/Remote Confrol
Swimming Pool
_ (,G�2/X/
:ti Request will not be accepted without ►he correct fee:
# Service Entrance Size Fee # Circuits/Feeders
0 to 200 Amps 0 to 100 Amps
Above 200 Am s Above 100 Ai
INSPECTOR'S USE ONLY TOT�
Fee
S �,S�D �
I hereb certi fhat I ins ecfed fhe electrical insfallafion described herein on fhe dafes stated
Irrigation Boom - Roo9Mo pa�
Special In
Investigative Fee �10� � Dare � ^ � � Z
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFflCE USE ONLY This requesf void 18 monfhs from validafion dafe printed in fhis box.
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* 0 7 5 5 3 6 6 2* �dC�
PLEASE PRINT OR TYPE
Request Dafe Rough-in inspection required? ❑ Yes
❑ No Inspecfion Ofher Than Rough-In: Ready Now � Will Call
' �' �You musf call the inspecfor when ready) Date Ready:
I, icensed confractor ❑ owner hereby request inspection of the above electrical work at:
Job ddreu �Sheet, Box, or No.) Ciy� Zip Code
�-.� �- ��
Secfion No. ownship Name or No. Range No. Fire No. County
� Occupant
.. �U � �
Conhacfor (Company Name�
PENDABLE ELECTRIC, INC.
� ss $ r �ng�s�afio
�n Rapids, MN 55433
d Sipnature (Conhacfor or Owner P�rl6rmina IBsral
Phone No.
ccJ S- � �- S�do
Conhactor License No. Master Lic. No. (Planf Elecl.
('.����..3� , FG .� 3
� Phone No.
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�ONS ON BACK OF YELLOW COPY �-