P - 81006REQUEST FOR ELECTRICAL INSPECTION �
(l - p�S 5� c�� � Minnesota State Board of Electricity ,�
U G U V 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104-2993
; � (651) 642-0800 www.electricity.state.mn.us "��
"X" above ihe work covered by this request. Enter remarks in tl
_ C;�i2J1�
the white copy only.
Calcula►e Inspection Fee - hi nspection Request will not be accepted without the correct fee:
Other Installations Fee # Service Entrance Size Fee # Circuits / Peeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Skeet Ltg. / Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator WSPECTOR'S USE ONLY TOTAL
Sign / Outline Ltg. Xfmr. NF/� r�'��"�g ��•S�
Swimming Pool
Irricaation Boom
the electrical installation described herein on fhe dates stated:
Date
II(nvestigative Fee r� 1������ � � I V� �",S —a� I
THIS INSTALLATION MAY BE ORDERED DISC WECTED IF NOT COMPLETED WITHIN 18 MONTHS.
`^ � " OFFICE USE ONLY This request wid 18 months from validation date prinied in fhis box.
_ I�a�ii�iii�iHii������i� � �.�
* 0 8 6 5 6 8 2 9* ����
PLEASE PRINT OR TYPE
Requesf Dafe�� • Rough-in inspecfion required$ ❑ Yes ❑ No Inspection Ofher Than Rough-In: Ready Now ❑ Will Call
You musf call the inspector when ready Date Ready:
, licensed contractor ❑ company ❑ owner hereby request inspection of the above electrical work at:
Jo Address (Sheef, Box, or Rou o.)�/ �j� � , � Zip Code
'il7,`Z /'� //�lr �M t � _� /� �ii��l/�,Lr� �S` ��
or
Occupant
Power Supplier �� �
Elechical Contracror / Company Name
DEPENDABLE ELECTRIC
rna� ��S�otr°'f���l'�'YBI@'tl:efl�
Caon Rapids, MN 55433
Authorized Sis�nature ICont , ompany or Owi
�
COPY
No. Coun
Phone No.
r-�9
actor License No. Mastei
�� � J�.� /'
' � �)
Phone
�
SEE INSTRUCTI
J->vly.�
OF YELLOW COPY