P - 83813J
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REGIUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612)642-0800
Home Duplex Apt. Bldg. Other:
Commercial Industrial Farm
Air Cond. 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
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New
Remod
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the white copy only.
Calculate Inspection Fee - This Inspecfion Request will not be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders
Mobile Home Park Stall 0 to 200 Amps j 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOT/!L L
Sign/Outline Ltg. Xfmr. /✓
Alarm/Remote Control
Swimming Pool
I hereb certi that I ins ted the electrical installation described herein on the dates stated
Irrigation Boom Rough-In �}e
Special Inspecti
Fee
'sp
Investigative Fee Final Dat
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THIS INSTALLATION MAY BE ORDERED DISCO ECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFlCE USE ONLY This request void 18 months from validaticn date printed in this box.
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Requesf Date Rou h-in ins ecfion r
g p equired? ❑ Yes No Inspecfion Other Than Rough-In: eady Now ❑ Will Call
s t. 9 (You must call the inspector when ready) Date Ready:
f, �icensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sheet, Box, or Roufe No.) City Zip Code
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Section No. Township Name or No. Range No. Fire No. Coun
d
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Power
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Phone No.
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Elechical Confmctor �Company Name) Conhactor License No.
Harrison Electric, Inc. CA00 08
Mailing Address �Confractor or Owner Performing Installa}ion�
2 Nevada Avenue North, 301, Golden Valley
A fhqiz Sign u (C to er PerFornyjn Insf Ilation� "' /' � �
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A-1 1 8/9 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF'
55427
544-3300