P - 83533RE(]UEST FOR ELECTRICAL INSPECTION
7������ � Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
' Phone (612) 642-0800
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Home Duplex Apt. Bldg. Other: New
Commercial Industrial Farm Remoc
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 the white copy
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Calculate Inspection Fee - This Inspection Request will not be accepfed without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders
Mobile Home Park Stall 0 to 200 Amps ' 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above T00 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOT/►/�.
Sign/Outline Ltg. Xfmr. / �
Alarm/Remote Conhol
Swimmin Pool
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Fee
" 9 I hereb certi 1{�at I ins fhe eleckical installation described herein on the dafes stafed
Irrigptibn Boo - RougMn Date
Special lnsp
Investigative Fee �1OI _ Da�^ Pc�
THIS INSTALLATION MAY BE ORDEREO NECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requesf void 18 monfhs from wlidafion date printed in this box.
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*07249089� �379
PLEASE PRINT OR TY�PE
Requ f Date Rough-in inspecfion requiredZ ❑ Yes o Inspecfion Other Than RougMn: Now ❑ Will Call
��— �" �� �You must call the inspecfor when ready Date Ready:
I, licensed co�hactor ❑ owner hereby request inspecfion of the above electrical work at:
Job Addr�ss �Skcet, Bo or Route No.) ^ Ciy Zip Code
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Seclion No. Township Name or No. Range No. Fire No. �-Count�
Phone No.
Add�ess
d Conhactor �Company Name) Conhactw License No. Masler Lic. No.
Harrison Electric, Inc. CA00808
Address �Conhacfor or Owner Performing Insfallafion)
2525 Nevada Avenue North 301 Golden Valle MN 5
:ed Signature Conhactor ner forming Installation� A� r Phone No.
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lA-1 1 8/96 STATE BOAHO COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY