P - 834297,1�-709 �
r
ome Duplex
Commercial Industrial
Air Cond. Htg. Equl
Dryer ange
"X" above the work covered 6
REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity �
1821 University Ave., Rm. S-128, St. Paul, MN 55104 �`
Phone (612) 642-0800 `' '
Apt. Bldg. Other: New Addn
Farm Remod Re air
Water Htr. Load Mgmt. Other:
Elec. Heat Temp. Service
request. Enter remarks in this space and on the back of the white copy only.
�.��� •
Calculaie Inspection Fee - This Inspection Req est ill not be accepted wiihout the correct fee:
Other Fee # Serv�ce Entrance Size Fee Circuits/Feeders
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
$treet Ltg./Traffic Sig. - Above 200 Am s Above 100 Ampt
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
Sign/Outline Ltg. Xfmr.
0
Alarm/Remote Conhol
Swiinming Pool
I hereb certi fhat I ins ected the efetkical insmllation described herein on the dates stafed
Irrigation Boom Ro�9h-in oore
Speciallnspecti }•�. �/
Imestigative Fe � � -0 �'
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 monfhs 6om validafion date printed in fhis box.
I I�{ �{ {�i N ��� �� ��� �� �i�l� ��� I� �� � I� �� • %�
* 0 7 1 8 7 0 9 9* 7���
PLEASE PRINT OR TYPE
Request Dafe ,� Rough-in inspecfion required� ❑ Yes ❑ No Inspecfion Other Than RougMn: Ready Now � Will Call
(You must call the inspector when ready) Date Ready:
I, ❑ licensed contractor ❑ owner hereby request inspection of the above elechical work at:
lob Address (Sheet, Box, or Route N.) � Ciy e Zip Code
Sech n o. Township Name or No. Range o. Fire No. County �
Occupont
Address
hical Conhactor �Company Name�
PENDAB�E ELECTRIC. INC-
li �(�o Insk
�n Rapids. MN 554�
Phone No:
�� � -05�8"�
i. Master lic. No. (Plant Elec1. Only)
i � � %%�1.�"�' ��
�wner Performing Insfa ' n) �'� Phone No.
% —
STATE OAR OPY - SEE INSTRUCTIONS ON BACK OF Y �_._