P - 839634:�8-��6 �
Home Duplex
Commercial Industrial
ir Co Htg. Equi
ry i( Range %
"X" above ihe work covered b
RE(�UEST 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 Hh. Load Mgmt. Other:
Elec. Heat Temp. Service
request. Enter remarks in this space and on the back
copy
Calculate Inspection Fee - This Inspection Requesi will not be accepted wiihout the correcf fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 00 Ampr 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TO�'AL � JC'� �
Sign/Oudine Ltg. Xfmr. ��
Alarm/Remote Control
Swimming Pool
I hereb certi that I ins the elech'ical insmllafion dexribed herein on the dafes sfated
Irriaation Boom c..,�.�.. /'�* �re
Final � � �
Investigative Fee � Z �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 monfhs from validation date prinfed in this box.
i � ��,�/
I IIII II lil II I�I li III II III II11I��1 II III II lll I Illl ��� ��
* � 4 9 8 9 6 6 1* LEASE PRINT OR TYPE 7S' ��
Requesf Dafe Rough-in inspecfion required? Yes ❑ No Inspection O�er Than RougMn: ❑ Ready Now Call
— '� (You must call the inspector when ready� Date Ready:
I, licensed contractor ❑ ow�er hereby request inspection of the above elechical work at:
Job Address (Sheet, Box, or Roufe No.� Ci1y • Zip Code
� '..>l'•'
Section No. Township ame or No. Range o. ' Fire No. Coun �'
cXCURqfnt
U
Power Supplier �
s
Eleckical Conhactor �Company Name)
CITIES ELECTRIC, INC.
Mailing
A-11
� �
Phone No.
-�vUL�¢.�
Address
Conhactor License No. Master lic. No. (Planf
CA00361
dlafion� 2 5 6�, � Phone No.
Y- SEE INSTRUCTIONS ON BACK OF YELLOW COPY