P - 84678REGIUEST FOR ELECTRICAL INSPECTION =° �.
d� 9_�9 9 4 Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone(612)642-0800
Home Duplex Apt. Bidg. Other: New Addn
Commercial Indusfrial Farm
Air Cond Htg. Equip. Water Hfr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in fhis space and on ihe back of tF
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Calculate Inspection Fee - This Inspection Requesi will not be accepted wi►hout the correct fee:
Other Fee # Service Entrance Size Fee # Circuits
Mobile Home Park Stall 0 ro 200 Amps 0 to 100 A
Sheet Ltg./Traffic Sig. Above 200 Amps Above 100.
Transformer/Generator INSPECTOR'S USE ONLY
Sign/Oudine Ltg. Xfmr.
Alarm/Remote Conhol
Swimmins� Pool
i
the elecfrical insMllation described herein
�hite copy only.
�ders Fee
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_ Amps
TOTAL � ��
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ie dates stated
Dale
Investigative Fee ` ..M �-. �� ,�'
THIS INSTALLATION MAY BE ORDERED DI CTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validation date printed in this box.
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Requesf Date Rotgh-in inspecfion required$ ❑ Yes No Inspeclion Olher Than RougMn: Ready Now ❑ Will Call
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(�j ��)' i %� (You musf call the inspector when ready� Dafe Ready:
I, licensed conhactor ❑ owner hereby request inspection of the above elechical work at:
Job Addreu �Skcef, Box, or Route No.) Ci�y Z�P C�
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Section No. Township Name or No. Range No. Fire No. Counly
Occupant
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Power Supplier
Phone No.
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�lecirical Contractor �Company Name) Conhacior License No. Maste/ Lic. No. (Plant Elect.
iarrison Electric, Inc. CA00808
?163"��a`4tf�e1'�'2erOA��'�'^�@l��►th, 301, Golden Valley 55�27
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�TATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF vEUOw coav