P - 80742,��8-�59 �
Home
Commerci
Air Cond.
Dryer
"X" above the
Du
Inc
REGIUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity 3
1821 University Ave., Rm. S-128, St. Paul, MN 55104 =
Phone (612) 642-0800
Apt. Bldg. Other: New Addn
Farm Remod Re air
Water Htr. Load Mgmt. Other:
Elec. Heat Temp. Service
request. Enter remarks in this space and on the back of the white copy only.
�CiCiLY(/ / �% (s(/U / C '
Calculaie Inspection Fee - This Ins io Request will not be accepted wi►hout the correct fee:
Other F # Service Entrance Size Fee # Circuits/Feeders Fee
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�j
Sign/Oudine Lfg. Xfmr. Of�-.S�
Alarm/Remote Control
Swimming Pool
I hereb certi thaf I ins ted �e electrical installation described herein on the dates stated
Irrigation Boom Ro�Mn Dar�
$pecial Inspect '
F��d �, �iC3t�
Investigative Fee
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN i8 MONTHS.
OFFICE USE ONLY This request void 18 months from validation date prinfed in this box.
��� �) �II �� ��� �� ��� �� ��� ���� �� I� �� ���I •,�Qo
* 0 8 3 8 8 5 9 7* a� •�
PLEASE PRINT OR TYP
Requesf Date �� Rough-in inspecfion required? ❑ Yes ❑ No Inspection Ofher Than Rough-In Ready Now ❑ Will Call
��/ • �You must call the inspector when ready) Date Ready:
I, licensed contractor ❑ owner hereby request inspection of the above electrical work at:
1ob Ad�ress �Sheef, Box, or R� No.� O ^ Ci � Zip Code i
or
Occupant
Power uppier �^
�v�
Elecirical Conhacfor (Company Name�
DEPENDABLE ELECTRIC, INC.
�i a� qoa�h pt � uo
Phone No.
' �3��
Coon Rapids, MN 55433 ,� �3 �
Aufhorized Signature (Conhac ner PerForming Insfa fion� i Phone No.
�S 7 -.�O�O
E&00001 11 8/9 T BOARD COPY - SEE INSTAUCTIONS ON BACK OF YELLOW COPY