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P - 83573�78-711 � Home � � Duplex Commercial . Industrial woik REQUEST FOR ELECTRICAL INSPECTION Minnesota State Board of Electricity 1821 University Ave., Rm. S-128, St. Paul, MN 55104 Phone (6f2) 642-0800 Farm Remoc Water Htr. Load Mgmt. Other: Elec. Heat Temp. Service this request. Enter remarks in this space and on �he back of the white copy Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee: Other Fee # Service Eotrance Size Fee # Circuits/Feeders Mobile Home Park Stall 0 to 0 Amps 0 to 100 Amps Sfreet Ltg./TrafFic Sig. Above 200 Am s Above 100 Ai Transformer/Generator INSPECTOR'S USE ONLY TOT. � A�11a � t.. Fee Sign/Oudine ltg. Xfmr. � �• � Alarm/Remote Confrol �'� Swimming Pooi I hereb certi that I ins �� the elecnical ins Ilation described herein on the dales stated Irrigation Boom - , „ RougMn � D�� Special Inspecti ' j J Final � Dafe Imestigative Fee � - THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHI 18 M NTHS. � OFFICE USE ONLY This request void 18 monfhs kom validafion dafe prinfed in ihis box, IIIIIIIIIIIIIIIIIIIIIf II�IHf fIIIIINn�If IIII � �� * 0 6 7 8 7 1 L 3* �S� PLEASE PRINT OR TYPE Requesf Dafe � Rou h-in ins ection r uired? es g p eq ❑ No Inspection Other Than Rough-in: ❑ Ready Now Will Call �� You musf call fhe iospector when ready) Date Ready: I, icensed confractor ❑ owner hereby request inspection of the above electrical work at: Job Address (Sheet, Bo�„ or�oute No.) � • �> Ciry _ _ ^ Zip Code No. � Township Name or No. � Range No. � Fire No. A-1 1 Phone No. (Company Name� Conhactor License No. I Master Lic. No. CITIES ELECTRIC, INC. CA00 81 ��os ' � nfra o e e rmmg nsfiSllafj� �, $' O •ru� w • 1 (Conh ne 'on) � J� Phone No. STA7E BOARD COPY - SEE INSTRUCTONS ON BACK OF YELLOW COPY