P - 80743, REQUEST FOR ELECTRICAL INSPECTION -
p�',� O��� O Minnesota State Board of Electricity
� J O O � 1821 University Ave., Rm. S-128, St. Paul, MN 55104
� Phone (612) 642-0800 `�'
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Re air
Air 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 the whiie copy only.
�a�'C1 r (.� �
Calculate Inspection Fee - This Ins ti Request will not be accepted withou► the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR's usE oN�r TOTAL
Sign/Oudine Ltg. Xfmr. 7ti/���
Alarm Remote Control f'���� p�
Swimming Pool g'�6I " •
I her certi that I ins the elechical inslallafion described herein on the dates stated
Irrigation B R��� Dare
Special Ins ti n
� Dare,.s` .�
Investigative Fee /
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validation date prinfed in fhis box.
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* 0 8 3 8 8 5 8 9* 02�'�
PLEASE PRINT OR TYPE
Requ t Date Rougffin inspecfion required6 ❑ Yes ❑ No Inspection Olher Than Rough-In: Ready Now ❑ Will Call
• (You musf call ihe inspecfor when ready) Dale Ready:
I, icensed contractor ❑ owner hereby request inspection of the above elechical work ot:
Jo6 Addreu �Sheet, Box, or Roule , Ci ///� Zip Code
D � ✓(� W ��
Secfion No. Township Name or No. Ronge No. Fire No. Coun
Cc�.
Occupa Phone No. �
s- a - � �i
Power Supplier ' � � Address
E� DEPENDABLEYELE�CTRIC. INC. c�'TM� ���N��� �S�No.�PlantE���
E
Mai A es c ;n��llation� � �
Coon Rapids, MN 55433 `
Auihorized Signafure (Conhacror o er Performing Install 'on) Phone No.
- � �'�'�'�
EB-000 8/96 ST ARD COPY - SEE INSTRUCTIONS ON BACK OF Y W COPY