P - 83852��s-778 �
RE(�UEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800
New
Commercial dustrial Farm R� J
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Ra�ge Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on the back of the white
\' `� � �� I �
V��.�
Calculate Inspection Fee - This Inspection Request will noi be accepted wifhout the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeder,
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Amps Above 100 A
Transformer/Generator INSPECTOR'S USE ONLY TOl
Sign/Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool I hereb certi thaf I ins ted the electrical installation described herein on ihe da
Irriaation Boom Rouah-In �°�
�: '`�',.
� ?,:�.r :
�l� `
� '�
copy only.
stafed
Jf.�eciui uuNcuivih .� s
Final /
Investiqative Fee � ` l -----�"" � " �� � � �
THIS INSTALLATION MAY BE ORDERED DiSCONNECTED IF N07 COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requesf void 18 mon}hs from validafion dafe prinfed in tfiis box.
IIIIIIIIIIIIIIIII�IIIIIIIII�IIIIIIIIIIIIIIII , ��9a
* � 5 2 6 7� 8 6�K PLEASE PRINT OR TYPE l��
Requesi e� � Rough-in inspecfion required2 ❑ Yes No Inspection Olher Than Rough-In: Ready Now ❑ Will Call
� (You must call the inspector when ready� Date Ready:
I, licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, or Route No.) City �� Zip Code
��� 1�.�� �.� ��
ecti � No. Townshio Name or No. Ranqe No. Fire No. ount� _
Fower
=lectrical Conhacfor (Company Name)
Ha.rrison Electric, Inc. CA00
Nailing Address (Conhacfor or Owner Performing Installation�
2525 �e ada Avenue North, 301, Go
Ph��_ �.��
.�J
Master Lic. No.
den Valley 55427
Phone No.
•.� 544-3300
:K OF YELLOW COPY