P - 829245�r�-991 a
Home Duplex
Commercial Industri
I "X" above the work
REQUEST FOR ELECTRICAL INSPECTION �-
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800 '�'
Other: New Addn
Farm
Water Hfr, Load Mgmt. Other:
Elec. Heat Temp. Service
this request. Enter remarks in this space and on the
white copy
Calculate Inspection Fee - This Inspection Requesi will not be accep�ed without Ihe correct fee:
Other Fee # Servi e Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall to d0 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPEC70R�S USE ONLY T �
Sign/Oudine Lig. Xfmr. G��
Alarm/Remote Confrol
Swimming Pool
I her certi that I ins the elechical installation describad herein on the daNes sFO�ed
Irrigation Boom ��9�� � p�� ` �T � �
Special Inspectio
F��ai �
Invesfigafive Fee
THIS WSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFRCE USE ONLY This request void 1 S monfhs from valida6on dafe prinied in this box.
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PLEASE PRINT OR TYPE
Request Dafe Ro h�in ins
�9 p�� required$ Yes ❑ No Inspection Other Than RougMn: ❑ Ready Now Will Call
� (You musf call Ihe inspedor when ready) DaTe Ready:
I, licensed conhactor ❑ owner hereby request inspection oE the above electrical work at:
hb Addreu (Sheet, 8� ornRoup@ No.) . � c�ps�� � �, � , _ .
Name or
No.
Conkaclor �Compn^Y Name)
CITIES ELECTRIC, INC. CA0038i
�ddress (Confracfor or er er�ormin� In �qhnnl'O `
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Phone No.
x license No. �
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STATE BOARD COPY - 5EE INSTRUCi10NS ON BqCK OF YELLOW COPY