P - 83142- RE(�UEST FOR ELECTRICAL INSPECTION
5���(i O� Minnesota State Board of Electricity
J 0 1821 University Ave., Rm. S-128, St. Paul, MN 55104
` Phone (612) 642-OS00
Hom Duplex Apt. Bldg. Other: New
mmercial In Strial Farm Remoc
` Air C Htg. Equip. Water Htr. Load Mgmt. Other:
ry J Range Elec. Heat Temp. Service
"X" abo e work covered by this request. Enter remarks in this space and on the back of the white copy
Calculate Inspecfion Fee - This Inspection Request will not be accepied withoui the correci fee:
Other Fee # Service Entrance 'ze Fee # Circuits/Feedi
Mobile Home Park Stall Amps 0 to 100 Amps
Sheet Ltg./Tra{fic Sig. Above 200 Am s Above 100
Transformer/Generator INSPECTOR's use oN�v T(
Sign/Oudine Ltg. Xfmr. � ,(
Alarm/Remote Confrol l� 7
Swimming Pool
I here certi that I in Ihe electrical installalion described herein on �he �
Irriqation Boom R�,„i,.i„ „�, � �„
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Fee
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFlCE IISE ONLY This requestvad 18 months 6om validation dafe printed in this box.
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* � 5 6 6 9 8 2 5* PLEASE PRINT OR TYPE
Requesf D Rough-in inspecfion required$ Yes ❑ No Inspecfion OTher Than Rough-In: ❑ Reody Now Will Call
�/�t �� (You must call ihe inspecror when ready) Date Ready:
I, licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sheet, Box, or ule � Ciy Zip Code
� ��t S �� ��r-fis�e%►��s�. �r-� c.�. I
SecKon No. Township Name or No. Range No. Fire No. Counly�w
Phone No.
Conhacfor �Canpany Name) I Conhactor License No.
CITIES ELECTRIC, fNC. CA00381
3100-225TN ST W � F[;TN I�AN 5502�
uldress (Conhacror or Owner Performi��t�)
�L_ 0 ► a
d'wner�er�g Instalbtion) �� O � ^ �
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STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY