P - 81499REQUEST FOR ELECTRICAL INSPECTION
7��� 3�� = Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
, Phone(612)642-0800
Fiome Uuplex Apt.8ldg. Other: New A�
ommercial Industrial Farm Remod Re
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 the back of ihe white copy only.
oc�R.� ���
Calculaie Inspection Fee - This Inspection Request will not be accepted without fhe correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall tok00 Amps � 0 to 100 Amps
Sireet Ltg./Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR�S usE oN�Y TOTAL /��
Sign/Outline Ltg. Xfmr. �
mote Control
� Pool
I hereb certi ihat I ins ted ihe elechical insfallation descrlbed herein on the dates sfafed
g�m Rougn-In Date
va�
Imestigative Fee _ g..
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT CO�IIPLETED WITHIN 18 MONTHS.
OFFlCE USE ONLY This requesf void 18 months from validafion date prinfed in this box.
�������������������� IIIII) ������ ^ �5D' � -� �
� �
* 0 7 5 5 3 7 2 0� ��0 �
PLEASE PRINT OR TYPE
Requesf Date Rough-in inspecfion required? ❑ Yes
�'� � ❑ No Inspecfion Other Than Rough-In: Ready Now � Will Cal)
�You musf call the inspector when ready� Date Ready:
I, 'censed contractor ❑ owner hereby request inspection of the above electrical work at:
Job ddress (Sfreet, Box, r Route No.) Ciy Zi Code
/U � �� � �����
Secfion No. Township Name or No. Ranpe No. Fire No. Cou
\
Power
(�,�����<..�
Phone No.
S7/�3���
�.lectrical Conhactor (Company Name) Co fractor License No. Master Lic. No. �Planf Elecf.
DEPENDABLE ELECTRIC. INC. C�D�� � G �c�C 33
rYs�l6gl dr � Q�h �'��"��:m�i�fallation)
Coon Rapids, MN 55433
wfhorized Signature (Confracto ne� Performing s lafion) • Phone No.
�" �� ��
�-00001 1 1 8/96 TAT BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY