P - 83185REGIUEST FOR ELECTRICAL INSPECTION — _
5 C� � C� O� Minnesota State Board of Electriciry
�� � 0 1821 University Ave., Rm. S-128, St. Paul, MN 55104
` Phone (612) 642-0800
Home Duplex Apt. Bldg. Other: New Addn
Commercial Indushial Farm Remod Re air
Air Cond. �' Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in ihis space and on the back of the whiie copy only.
Calculate Inspeciion Fee - This Inspe
Other Fee
Mobile Home Park Stall
Street Ltg./Traffic Sig.
Transformer/Generator
Sign/Oudine Ltg. Xfmr.
Alarm/Remote Conhol
Swimming Pool
Irrigation Boom ,
Specia4 Inspection
Imestigative Fee
�n Request will not be accepted without the correct fee:
# Servic Entrance Size Fee # Circuits/Feeders
00 Amp 0 to 100 Amps
Above 200 Am s Above 100 Ai
INSPECTOR'S USE ONLY TOT
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I herebvi certifv that I insoeded the eleclrical insfallafion described herein on Ihe dah
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THIS INSTALLATION MAY BE ORDERED DIBCONNECTED tF NOT CO�IIPLETED WITHIN 18 MoNrMS.
pFF10E USE OPiLY This requesf void T8 monihs from vaL'dano� da� P���rad �� d.�s �x.
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�K � 5 6 6 9 8 7�i * PLEASE PRINT OR TYPE
Requesf te � Raugh-in inspecfion required? Yes ❑ No Inspeclion Olher lhan RougMn: ❑ Ready Now Will Call
� (You musf call the inspecror when ready) Dafe Ready:
I, licensed contractor ❑ owner hereby request inspection of the above electrical work at:
�l � ��, soX. o a� �., � �`" �i1�i` GC. � rP �
Seciion No. Township Name or No. Range No. Fire No. Couny�� � .
Fee
Phone No.
Elechical Conhactor (Company�l�S ELECTRIC� INC. C 04381 u�� � �star �c. No. lPu
5100-225Tii ST. W., rG Ti'd., M 55024
Mailing Address �ConhacTor w er PerForming I tallation) -381 O
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Authorized Signature (Conha r or Owner P ing Insfal n� Phone No.
EB00001 A-11 8/96 y�p� g�ppD COPY - SEE INSTRUC710NS ON BAC F YELLOW COPY