P - 83401�' REQUEST FOR ELECTRICAL INSPECTiON =-
�G` C� C� Q O 0 Minnesota State Board of Electriciry
U�� J�� 0 1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800 "�°'
Home Duplex Apt. Bldg. Other: ew Addn
Commercial Industrial Farm Remod Re air
Air Cond. . Equip. Water Hfr. Load Mgmt. Other:
Dryer ng Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
Cakulate lnspection fee - This lnspection Request will not be accepled wi►houi the correct fee:
Other Fee # Service Entrance Size Fee # eircuits/Feeders Fee
Mobile Home Park Stall to 00 Amp '' 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOT� ��!,
Sign/Outline Ltg. Xfmc �v/% �'J
Alarm/Remote Conhol
Swimming Pool
I h ceAi that I in ted the lechical installation described herein on the da�es slated
Irrigation Boom . RougMo i Da�e
Special Inspecti " i �`� � �� �
Frwl
investigotive Fee �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WI HIN 18 MON S.
OFFlCE U� ONLY This reques� void 18 monfhs from validafion dole prin�ed in Ihis box.
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!1!!! �Il�) ��l�! �/3.3
* � J� (a 6 9 9 8 L* PLEASE PRINT OR TYPE
Re�ues� � Rou fFin ins
� g peclion required2 Yes ❑ No Inspeclion O�her Than RougMn: ❑ Ready Now ill Call �
(� �� �You must call 1he inspecror when ready� Dape Ready:
I, icensed conhactor ❑ owner hereby request inspection of ihe above electrical work at:
Job+Address �Sheet, Box, w�u�o.) . . Ciy�/ ^ n Zip Code
i�
� Seclion No. � Township Name w No.
� PwvE.v
Fire No.
Phone No.
r(Company Name) Conhactor license No. Masper Lic. No. �%aM
CITIES ELECTRIC, INC. CA00381
S16G-2��T�iST y► �� ?!�-!- ti1N 55024
.ontracbr or Owner PerForming J�qil�r�
w �
r e tallation) ��� Pfwrre No.
b STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY