P - 83353REQUEST FOR ELECTRICAL INSPECTION °"
.:e,
'7 �- 619 C� 8'21 University Ave.,rRm. Se128,ISt. Paul, MN 55104 �
i
Phone(612)642-0800
Home Duplex Apt. Bldg. Other: ` New Addn
Co ercial I strial Farm %r �—��/� Cr Remod Re air
ir Cond. Htg. Equip. Water Htr. Loa Mgmt. Other:
ryer Range Elec. Heat Temp. Service
"X" abOV� e work covere�t is request. Enter remarks in this space and on the back of the white copy only.
� L /ti `
t� Li �
Ib� c�x�n�p -��� �c�4. �Ulcs�.�
Calculate Inspection Fee - This Inspection Request will nof be accepted wiihout the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders
Mobile Home Park Stoll ' 0 to 200 Amps �.00 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Amps Above 100 Amp;
Transformer/Generator INSPECTOR°s usE oN�v TOTAL
Siqn/Outline lta. Xfmr. �
Swimming Pool
I hereb certi that I ins ted the elechical installation described herein on the dates stated
Irrigation Boom RougMn oar�
Special Inspec .
Fee
�C
Investigative Fee ��� � ""j2 a
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFlCE USE ONLY This request void 18 months from validation ate rinf in his box.
���
l Ilil II {�I I{ II{ {� {I� �� ��I �I�M�fH� � �� �� �� �
* 0 7 0 6 6 1 9 4* ��,� V
PLEASE PRINT OR TYPE
Request Date Rough-in inspection required8 ❑ Yes ❑ No Inspecfion Other Than Rough-In: ❑ Ready Now ❑ Will Call
�You must call the inspector when ready) Date Ready:
I, licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Jo A ye¢s Street,Box,yryRoute�N � �-- Ciy� ZipCode
�� � (/t r ��
Secfion No. Township Name or No. Range No. Fire No. Cou � ��
�
Phone No.
Lic. No.
or Owner
1 8/96 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY
/ V �/ C/