P - 83104REQUEST FOR ELECTRICAL INSPECTION
�'1 ^�' /I G� Minnesota State Board of Electricity
1�. J i't � 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 ►he work covered by this requesf. Enter remarks in this space and on ihe back of the white copy only.
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Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders ee
Mobile Home Park Stall 0 ro 200 Amps 0 to 100 Amps
Sheet Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL ��
Sign/Outline Ltg. Xfmr. �
Alarm/Remote Conhol
Swimming Pool
I hereb certi that I ins ted fhe elechical insMllation described herein on the dates stated
�RlqdtI0I1 BOOftI - Rn�u,h-In Dafe
Investigative F� �i±V � ` C �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WIT 18 MONTHS.
OFFICE USE ONLY This requesf void 18 months from validafion date printed in this box.
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PLEASE PRINT OR TYPE
Requesf Dafe -� _/ Rough-in inspecfion required? ❑ Yes ❑ No Inspeclion Other Than RougMn: Ready Now ❑ Will Call
c7� b/ (You must wll the inspector when ready) Date Ready:
I, licensed contractor ❑ owner hereby request inspection of the above electrical work ot:
Jo Address ��� Box, or le No.� Ciry /` Zip C—ode�
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Seclion No. Township Name or No. Range No. Fire No. Coun �
PENDABLE ELECTRI(
n, A o �
on Rapids. MN 5543
horized Signature (Conh d' r or Owner
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-11 8/96 TATI
INC.
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BOARD COPY - SEE INSTRUCTIONS
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Phone No.
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No. Master Lic. No. �Plant Elect. Only)
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Phone No. ^
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.QF YELLOW COPY