P - 84596REQUEST FOR ELECTRICAL INSPECTION
��� O- 2 4 0 Minnesota State Board of Electricity
1821 Uni��ersity Ave., Rm. S-128, St. Paul, MN 55104 �,
Phone(612)642-0800
Home Duplex Apt. Bldg. Other: New Addn
Commercial Indushial Farm Remod Re ir
ir Cond. ' Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on the back of fhe white copy only.
Calculate Inspection Fee - This Inspeciion Request will not be accepted wiihout fhe correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall to 00 Am , 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps �
Transformer/Generator INSPECTOR'S USE ONLY TOI.A�
$ign/Outline Ltg. X�rnr. y�
Alarm/Remote Control
Swimming Pool
I hereb certi fhat I' fed the elechical installafion described herein on the dates stated
Irrigation Boom RougMn p� _� n
Special Inspection �9 •- Z"
Rnal
Investigative Fee �! `'
_ THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN f8 MONTHS.
OFFICE USE ONLY This request void 18 monfhs from validation date printed in this box.
I IIII II III II �II II ''\
���Illtll I��I��I��I��I��N����� ��sD
* � 4 4 8 2 4 � 2* PLEASE PRINT OR TYPE _����%
Request Dafe Rough-in inspecfion required2 es
❑ No Inspecfion Olher Than Rough-In: ❑ Ready Now i Call
��� G� �� � (You must call the inspector when ready� Date Ready:
I, icensed contractor ❑ owner hereby request inspection of the above elechical work at:
1ob Address (Skeef, Box, or Route No.� City ' Zip Code
i`�V ��
$eclion o. Township Name or No. Range No. Fire No. County
Ok
Occu�t Phone No.
�������� ��,ompany rvame� Conhactor License No. AAaster Lia No. (PIaM Elecf.
CITIES ELECTRIC, INC. CA00381
MN 55024
Mailing Address (Conhaclor or Owner Perfa��fion)
� �
Authorized Si onfr er ing Insfallafion) ���^ Phone No.
V
E&OOOOIA-11 8/96 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPv