P - 82129REQUEST FOR ELECTRICAL INSPECTION
8.t� �� -19 6� 8121eUni essty A earRm. S-128,ISt. Paul, MN 55104 �'
i Phone (612) 642-0800 "�'
Home Duplex Apt. Bldg. Other: � New Addn
Commercial Industrial Farm ,� ` Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mg . Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Emer remarks in this space and on Ihe back of the white copy only.
Calculate Inspecfion Fee - This Inspection Requesf will noi be accepted withouf the correcf fee:
Other Fee # Service Entranc Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 00 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONIY TOTA����
Sign/Outline Ltg. Xfmr. ,{� �/�.y� �D I(L-G �
Alarm/Remote Confrol U
Swimming Pool I hereb certi fhat I ins ted the elechical insfallafion described herein on fhe dates sMfed
Irrigation Boom RagMn Dare
Special Inspect'
Final D
Investigative F � �-�%� dQ
THIS INSTALLATION MAY E ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 monfhs from validafion dafe prinfed in fhis box.
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PLEASE PRINT OR TYPE
Reque^st Dafe Rou h-in ins fion r uiredZ ❑ Yes
g pec eq ❑ No Inspecfion Ofher Than Rough-In: ❑ Ready Now ❑ Will Call
"�' g^ Q O �`!ou must call the inspector when readyi Date Ready:
I, ❑ licensed contractor �owner hereby request inspection of the above elechical work at:
1ob Address �Sfrcef, Box, or Roufe No.) City Zip Code
�03� a a� 5-� �- ��; re �s y3o�
Section No. Township Name or t�p� Range No. Fire No. Cou y
a�.,� °�� t�%VO�i�
Occupant Phone No.
1���t f�t � K � b 3��I � 8 3�
Power Supplier Address �
1...> ��
Electrical Conhacfor �Com ame� � Contmcfor License No. Masfer Lic. No. �Planf Elecf. Only)
�
Mailing Address (ConMacror or Owner Perfor ing Insrollafion)
1�03 �=2 s N� �F'r; � sS 3�
Aufhorized Signafure (Conhacf er PerForming Ins afion) p� Phone No.
� ��r 3 s�i s3a
EB-0OOOlA-11 8/96 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY