P - 83992REGIUEST FOR ELECTRICAL INSPECTION
5� r•1 � 3 3 7 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 ddn
Commercial dustrial Farm Remod Re air
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 only.
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Calculate Inspection Fee - This Inspection Request will not be accepied without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL �I
$ign/Outline Ltg. Xfmr. ��• � v
Alarm/Remote Control
Swimming Pool
I hereb ceAi �at I ins ted the elechical installafion described herein on the dates stafed
Irrigation Boom Rough-In �°�
Special Inspection _ pa
Final h'i7 � / _ Qrj
Investigative Fee ��-
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF_NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months (rom ralidafion date prinfed in this box.
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Request Date �� Rough-in inspecfion required2 ❑ Yes o Inspeclion Other Than RougMn: Ready Now � Will Call
(You must call the inspector when ready) Date Ready:
I, i ense contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sfreet, Box�r Route o.) � �, City Z'P COde
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Power
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Phone No.�,_,
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Elechical Conhactor (Company Name) Conhaclor license No. I
Harrison Electric, Inc. CA00808
Mailing Address (Contracfor or Owner Performing Insiallation)
2 2 evada North 301 Golden Vall
Authoriz $ign re a'haeor wne rfor ing Insfallati � )
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IB-00001 A- 96 ST E BOARD COPY - SEE INSTRUCTIONS ON BACK OF VELLOW COP
Lic. No.
55427
No.
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