P - 82902REQUEST FOR ELECTRICAL INSPECTION
6/� /� � p�� � Minnesota State Board of Electricity
��r �f o 1821 University Ave., Rm_ S-128, St. Paul, MN 55104 �
' Phone(612)642-0800
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Re ir
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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Calculpte Inspection Fee - This Inspection Request will not be accepted wifhou� ihe correct fee:
Other Fee # Service Entrance Size Fee Circuits/Feeders ee
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
Sign/Outline Ltg. Xfmr. Is ' ��
Alarm/Remote Control
Swimming Pool
I hereb certi thaf I ins the eleclrical insfallafion described herein on the dafes stafed
Irrigation Boom Ro�9hao Dore
$pecial Inspecti
Investigative Fee � � ' ��� � �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 monihs from validafion date printed in ihis box.
INI�II��I����I���N���N�III��I��I������ • ls�j
* 0 6 4 4 8 6 1 ?� l�`7`
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PLEASE PRINT OR TYPE
Request D te Roughin inspection required? ❑ Yes ❑ No Inspecfion Other Than Rough-In: Ready Now ❑ Will Call
'�' �� �You musf call the inspector when ready) Date Ready:
I, icensed contracror ❑ owner hereby request inspection of the above electrical work at:
Job dress �Sheet, Box, or R ufe o.) _ � City Zip Code �
c �
S ion No. Township ame or No. Range No. Fire No. Coun � �
� Occupant
•rr,o �� I , I (
Contractor (Company Name�
NDABLE EL�C7RtC, INC.
A�Bf�o��l�i�=O���rfo�� Insfallation)
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RtpiQa, AAN �,5433
3d Sipnafure acror or Owner Perfqfmi�lq Insfallafion� ��� �(� P
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COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY
Phone No.
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No. _ . � Mas�er L�. No.
- 50�1(�