P - 83180REQUEST FOR ELECTRICAL INSPECTION
6��� ��� � Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
,�' Phone (612) 642-0800
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Re air
Air Co � Htg. Equip. Water Htr. Lood Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered 6 this reques . Enter remarks in this space and on the back of the white copy only.
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Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stali 0 to 200 Amps to 100 Amps
Sheet Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
Sign/Oudine Ltg. XFmr. �. s�
Alarm/Remote Control
Swimming Pool
I hereb certi that I ins fed iFie eleclrical installation described herein on the dafes sfated
Irri9ation Boom _ Rough-In Date
Special Inspecti
Final
Investigative Fee � —
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18_ ONTHS.
OFFICE USE ONLY This roquest wid 1@ months (rom validation date printed in this box.
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PLEASE PRINT OR TYPE
Requesf Date Rough-in inspecfion required? ❑ Yes ❑ No Inspecfion Other Than Rough-In: Ready Now 0 Will Cal)
��//' g (You must call the inspec�or when ready� Date Ready:
I, licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job� Address heet, Box, or Route .) Ci � /� Zip Code
Q.,01�C. �
Secfion No. Township Name or No. Range No. Fire No. Coun
�
Occupant ^ Phone No.
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Power Supplier Address
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Elechical Contracror �Company Name) C nh r License o. / Master Lic. No. (Planf Elec1. Only)
DEPENDABLE ELEC7RIC, INC. ��
dr h �r¢ i IlaHon)
C�on Rapids, MN 433
Autfwrized Sigrwture �Co r or Owner Perform' g Insto{IaTion) ��* Phone No.
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EB-00001 A-11 8 9 pT BOARD COPY - SEE INSTRUCTIONS UN BACK OF YELLOW COPY