P - 83304.
6�"�°707 �
Home Duplex
Commercial Industrial
' Cond. Htg. Equl
Dryer Range
"X" above the work covered b
REGIUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, fvlN 55104
Phone (612) 642-0800
Apt. Bldg. Other: e
Farm Re
Water Htr. Load Mgmt. Other:
Elec. Heat Temp. Service
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�Addn1
request. Enter remarks in this space and on the back of the white copy only.
Calculate lnspection Fee - This lnspection Request wil! not be accep�ed wilhou► ihe correc► fee:
Other Fee #$ervi e Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 00 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator iNSPECTOR�S USE ONLY TOTAL � G
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Sign/Oudine Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
I hereb ceAi ihat I ins the elechical i taUotion described herein on the dates stated
Irriaation Boom uti�.�.. - n„�, � �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
� OFFICE USE ONLY This request void 1 S months fro a' tio dafe printedj�this box.
Illllllllllllllllllilllllll���lllilll(�Illlllllll ��`f
* 0.6 7� 7 0 7 1 * '� ��
PLEASE PRiNT OR TYPE
Request Date � Rou h-in ins ion r uired? es
g pecf eq ❑ No Inspection Ofher Than Rough-In: ❑ Ready Now ill Call
' �� 3 � (You musf call ihe inspector when ready) Date Ready: .
I, icensed contractor ❑ owner hereby request inspection of the above electrical work at:
lob Address (Sheet, Box, or Ijpufe No.) , � Ciy�.. � /� Zip Code
No. I Township Name or No. I Range No. I Fire No.
Phone No.
Elecfricol Con oclor (Compony Name) Conhacfor License No. Masfer Lic.
CITIES ELECTRIC, INC. CA00381
Maiting Address (Con a ' 9+7 ) �M ��
463-381p
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Authorized Signatur w �nsmtlafion� � �y� �� Phone No.
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E&00001 A-11 8/96 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY