P - 82883. REQUEST FOR ELECTRICAL INSPECTION �--
�/� �� p�� � Minnesota State Board of Electriciry
�f O 1821 University Ave., Rm. S-i28, St. Paul, MN 55104
Phone(612) 642-0800
ome Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air o 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 1he whiie copy only.
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Calculaie Inspection Fee - This Inspection Request will not be accepted without 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 ONLY TOTAL
Sign/Outline Ltg. Xfmr. � � `s�
AlarmJRemote Conhol
Swimming Pool
I hereb certi that I ins the elechical inslallafion described herein on the dates sta�ed
Irriqation Boom R,,,,,,�,i„ par�
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Imestigative fee Z 22'"�'
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
. OFFICE USE ONLY This requesf void 18 months from validafion dafe prinfed in this box.
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PLEASE PRINT OR TYPE
Requesf Date Rough-in inspecfion required$ ❑ Yes ❑ No Inspec6on Other Than RougMn: Ready Now � Will Call
�You musf call the inspecbr when ready� Dafe Ready:
I, licensed contractor ❑ owner hereby request inspection of the above elechical work at:
Job A dress (Sheet, Box, or Route No.) Ci� Zip Code
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Secfion No. Township Name or o. Range No. Fire No. C �
Phone No.
Power
PENDABLE mE�LECT�IC. INC. � a rLicenseNo. Masterlic.
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m Rapi s. M N 5 5 4�ming Insfallafion) �!' R^� +
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1 8/ 6 ST TE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY