P - 83972� � -975 ��
Home Duplex
Commercial Industrial
Air Co ;� ; t . Equ
Drye � Rang �+
"X" above the work covere
REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electriciry
1821 University Ave., Rm. S-128, St. Paul, MN 55104 �
Phone (612) 642-0800
Apt. Bldg. Other: New Addn
Farm Remod Re air
Water Htr. Load Mgmt. Other:
Elec. Heat Temp. Service
request. Enter remarks in this space and on the back of the white copy only.
Calculate Inspection Fee - This Inspection Request will not be accepied without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders
Mobile Home Park Stall 00 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Am
Transformer/Generator INSPECTOR'S USE ONLY TOTA
Sign/Outline Ltg. Xfmr. I,� '�
Alarm/Remote Confrol '�( �
Swimming Pool
Fee
� �
I hereb certi that 1 ins ected the eleclr'cal installaKon described herein on the dates sfated
Irrigation Boom RougMn i pa [
$p2CIO� �f15D2C�il � � C %1 � �I .
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFlCE USE ONLY This requesf void 18 months from validation dafe prinfed in fhis box.
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* � 4 9 8 9 7 5 2* PLEASE PRINT OR TYPE �5 '��
Requesf Dote Rou h-in ins ction r uired? es
��— g pe eq ❑ No Inspecfion Olher Than RougMn: ❑ Ready Now Will Call
�You must call ihe inspecfor when ready) Date Ready:
I, icensed contractor ❑ owner hereby request inspection of the above elechical work at:
Job Address (Sheef, Box, or Roufe No.) City� Zip Code
(� y � 1 �2 � 21 �oL�e
Section No. Township Name or No. Range No. Fire No. Couny �
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occopo�_r„
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Power Suoolier
EB 0000
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cror�Company Name)
CITIES ELECTRIC, INC. CA00381
�P � � 55024
463-3810
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� br �P �j,g Insfallafion)
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/96 STATE BOARD COPY - SEE INST
Conhacfor
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Phone No.
Master Lic. No. (Plant
No.