P - 80730REQUEST FOR ELECTRICAL INSPECTION
8���'j � Q ' Minnesota State Board of Electricity 3
* .L V i821 University Ave., Rm. S-128, St. Paul, MN 551.04
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Phone(612) 642-0800
Home puplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Re air
Air Cond. Htg. E uip. 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 white copy only.
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Calculaie Inspecfion Fee - This Inspection uest will not be accepted without the correc► fee:
Other Fee # Service Entrance Size Fee # Circuhs/feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg.fTraffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR's usE oN�v TOTA'..��„
SignfOudi�e Ltg. XEmr.
Alarm/Remote Confrol � ��w
Swimming PoQI
I here cerTi that I ins the electricai installation described herein on �e dates stated
Irrigation Boom RougMn Dare
Speciallnspectio ,-�
fii�al D
Investigative Fee d�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF N07 COMPLETED WITHIN 18 MONTtiS.
. OFFICE USE ONLY This requesf void 18 month alidation daie printed in fhis box.
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PLEASE PRINT OR TYPE
Reques te Rough-in inspeclion required? ❑ Yes ❑ No Inspection Olher Than Rough�ln: eady Now � Will Call
�' �`/ou must call the inspector when ready) Date Ready:
I, icensed contractor ❑ owner hereby request inspection of the above elechicai work at:
Job Address (Street, Box, or ufe No.) . City � Zip Code ��
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Seclion No. Township Name or No. Range No. Fire No. County
Occupanf � � Phone No.
DEPENDABLE ELECTRIC. INC. I C�O��i3� I/'1%��
Adal'e3s`{(:o^ o ^ o •ns , n�
Ceon Rapids, MN 55433
ed Signature �Confr er Performing tallafion) �.�, w^`� f' Phone No.
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��� � 8 ATE BO RD COPY - SEE INSTRUCTIONS ON BA OW COPY