P - 81421RE�UEST FOR ELECTRICAL INSPECTION "°�°�'€�
71 �- 3 6 9� 8121eUniversary Ave. rRm. 5-128, St. Paul, MN 55104 ���
Phone (612) 642-0800 �
X Home Duplez Apt Bldg. Ofhec New Addn
Commercial Industriol Farm Remod Re air
Air Cond. X Htg. Equip. Wafer Htr. Load Mgmi. Olher:
Dryer Range Elec. Heat Temp. Service
"X" above /he work covered by Ihis iequesf. Enler remoiks in fhis space and on the back of the whife copy only.
Calculofe Inspecfion Fee - This Inspec/ion Requesf will nof be accepfed wifhoul fhe mrrecf {ee:
Other Fee N Service Enfrance Size Fee # Circuits/Feeders Fee
Mabile Home Park 51a11 0 10 200 Amps 0 to 100 Amps
$freet Lfg./TraHic Sig. Above 200_Am s Above 100_Amps
Tronsiormer/Generator INSPECTOWS USE ONLV , TOTAL _
�"������������V�� Ihereb cani fiarlinsec�edrheelecrc�col-m.�alla��ondesn�bedhereinonthedaiesnoted
Irrigalion Boom Roughln Dare
Speciallnspec �
Fiin4 D
Invesligafive Fee � � —
71115 INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WIT N 18 MONTHS.
OFFICE USE ONLY This requeslwid 78 Mhs h m ml doYOn dme primed In this box.
�ulll �� � I�� I�����I��I I� ������II � �, 3�� �
x❑ 7 1 3 3 6 9 7*
PLEASE PRINT OR TYPE
x��e�r oar� 1-18-99 ao�9h.�� ���a�ro� ,���,ed? ❑ ve, C�o i�.�no� o�e� n,o� rzo�sh-m C�aeody Now 0 wai coii
(Yoo mosicallllie inspedorwhen readyl Da�e Reody:
I, � licensed confraclor ❑ owner hereby requesf inspecfion of Ihe above elecVical work af:
Jab Address (SVeel, 6oz, or Roule No ) Ciy Zlp Code
4590 3rd St NE FRidley 55421
Sxtion Na. iownship Name or No. Ron9e No. fire Na. Couny
Occupom
Pam Robinson
No.
574-1981
Electric Inc. I CA02749 I
.s Icom,a�io, o, ow�e, ae,ro,m��y i�.miiano��
Man�to ST NE iil Blaine MN 5544�
, �r
qn IConhacror or Owner Per inq Ms�ally1mil n i1 �fl T[ '%i 1 Pho�e No.
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