P - 84536REQUEST FOR ELECTRICAL INSPECTION -
'-"� V 8•�• o O 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 Indusfrial Farm Remod Re air
Air Conc� Htg. Equip. Water Hh. Load Mgmt. Other.
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by fhis request. Enter remarks in ihis space and on the back of the white copy only.
�v�r.�,ee,Q�s � l/y�6�
Calculate Inspecfion Fee - This Inspection Request will not be acc�
Other Fee # Service Entrance Size
Mobile Home Park Stall 0 to 200 Amps
Street Ltg./Traffic Sig. Above 200 Amp
Transformer/Generator INSPECTOR'S USE ONLY
Sign/Oudine Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
1 hereb certi that I ins ed the electrical installation described herein on the dates smted
Irrigation Boom Rough-In Date
without the correct fee:
Fee # Circuits/Feeders
0 to 100 Amps
Above 100 Amp;
TOTAL
Fee
Investigative � nnai � - C��
L
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
iHIS - - ------ — _
OFFICE USE ONLY This request void 18 mond� (� �o�.� ' — •
m
�ss� '�-�=°
I���i�llllllll�l "�� ;
* 0 4 6 8 � 0 6 2* EASE PRINT OR TYPE '``�
RB�� �°k � Rough-in inspection required2 ❑ Yes No Inspecfion Ofher Than Rough-In: Reody Now ❑ Will Call
�� � �You must call the inspecfor when ready) Dafe Ready:
I, (icensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sheet, Box, or Route No.� C� P
�l � �,/Taf!'�l�V��N �4'[ir� H �� Zi Codej
��� '
SecFion No. Township Name or No. Range No. Fire No. County� �
Occu t
/�l S,d�G /��t�+��?�tl.�'
Power Supplier
=al Confracfor (Company Name)
Harrison Electric
g Address (Conhactor or Owner Per(urming Inst
�
Conhocfor License
Phone No.
�1 �.Z `�% �
Lic. No. (Plant
-- - - - - " " " -' ' - �BTfiE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY
—ZSmxx7Tx-tQ s�vs - -- _ arATt-aomro cor i - sec�nsrxo�T�vrrsvR �vr��LVwcv� _—__-___
� �� [o-cmniin-�,v .�.,� -... _....--_""'_----_�'--