P - 83877REQUEST FOR ELECTRICAL INSPECTION
5,L b���� � � 8121eUniversty A earRm. S-128,'St. Paul, MN 55104
-• Phone (612) 642-0800
ome Duplex Apt. Bldg. Other: New Addn
Commercial Indushial 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 request. Enter remarks in this space and on the back of the white copy only.
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Calculate Inspection Fee - This Inspeciion Request will not be accepled 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 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTA
Sign/Outline Ltg. Xfmr. �
Alarm/Remote Control
Swimming Pool
I hereb certi }hat I ins ected the elechical insfallation described herein on the dates stated
Irrigation Boom RougMn Dafe
Special Inspection � '° j— �-
� Fino�
Investigative Fee ' �ti � ' �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITFiIN 18 MONTHS.
OFFICE USE ONLY This requesf void 1 S months from validafion dafe prinfFxi in this box.
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Request Date � � Rough-in inspection required? ❑ Yes o Inspection Other Than Rough-In: eady Now ❑ Wil) Call
(You must call the inspecfor when ready) Dafe Ready:
I, licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address �Sheef, Box, oc Route No.� City �, ,� Zip Code ',
S�� G�G � �U-UC!lu.� C��1r P� < <
Section No. Township Name or No. Range No. Fire No. County �.
.� �' S��- 3�-22�
Power Supplier Address
Elechical Conhacfor �Company Name) Conhacfor License No. Master Lic. No. �Plan
Harrison Electric, Inc. CAO 808
Mailing Address (Conhactor or Owner Performing Insiallation�
25 Nev�da Ave � North, 301, Golden Valley 55427
Au rized ignature onh or e ming Installation Pfwne No.
" r � ':� 544-3300
1 A-11 8/96 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY