P - 83187REQUEST FOR ELECTRICAL INSPECTION -
5� i7 - 9 8 5 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 Addn
Commercial Industrial Farm Remod Re air
i� Cond. ig. Equip. Water Hir. Load Mgmt. Other.
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by ihis request. Enier remarks in this space and on the bock of the white copy only.
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Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # 5ervice Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Pork Stall to 00 Amps to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOT �
Sign/Outline Ltg. Xfmr. u�c
Alarm/Remote Conhol
Swimming Pool I hereb certi that I ins the elecMical 'nstallafion described herein on ihe dates staled
Irri ation Boom eougMo Do
Special Inspectio " �' �
Final
Investigative Fce -� �
THIS INSTALLATION MAY BE ORDERED dSCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFRCE U� ONLY This roqu�sf wid 18 monfhs from validation date printed in this box. �
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* � 5 6 6 9 8 5 8* PLEASE PRINT OR TYPE
Requ4s' Dofe Rough-in inspeclion required$ es ❑ No Inspecfion Other Than RougMn: ❑ Reody Now ill Call
�--�' I,� g (l'ou musr call the inspecror whe dy) Dute Ready:
I, licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Addreu �Street, Box, or Route No.�, Ciy � . Zip Code
SecFion No. ownship Name or No. Range No. Fire No. Counly �
I Power
No.
il Contracror (Company Name) Conhacror License No. Master Lic.
CITIES ELECTpIC, INC. A00381
Address (Conhaclor or , Aat; ••
��10
� �
ed SignaNre (Contractor o Phone No.
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IA-11 8/96 y�p� g�ppD COPY- SEE WSTRUCl10NS ON BACK OF YELLOW COPY