P - 79702' REGIUEST FOR ELECTRICAL INSPECTION
��_� o� � 8121 University A earRm. S-128,ISt. Paul, MN 55104
" Phone(612) 642-0800
Home Duplex Apt. Bldg. Other ,/�� , New Addn
Commercial Industrial Farm /V� ' Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. ther:
Dryer Range Elec. Heat Temp. $ervice
"X" above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
Calculate lnspection Fee - This Inspection Request will nof be accepfed wifhout the correci fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer�Generato� INSPECTOR'S USE ONLY TOT�L, �
Siqn/Outline Ltq. Xfmr. � ! '
Swimming Pool t7 �
I eb certi �at I ins the el 'cal install ri r i n the dates stated
Irrigation Boom Ro�yl�ln Dar� ` � � �
Speciallnspection '�t°L �_
I
Investigative Fee � i�c,a�� �� � `Z� �'-� I
THIS IN�ALLATION MAY BE ORDERED DISCONNECT D IF NOT COMPLETED WITHIN 18'�MONTHS.
OFRCE USE ONLY This requesf void 18 monfhs from validation dafe printed in this box.
1 II� II II) I� I�� �I I�I II �I� I� III II �II II ��� ��
* 0 8 0 2 3 0 3 d� * �� j�l��
PLEASE PRINT OR TYPE �
Request ie Rou h-in ins Kon r uired? es
�� g pec eq ❑ No Inspecfion Other Than RougMn: ❑ Ready Now ❑ Will Call
(You must call fhe inspector when ready) Dafe Ready:
I, ❑ licensed contractor �, owner hereby request inspection of the above electrical work at:
Job Addreu (Sheet, Box, or Roufe No.) City Zip Code
�l� �/`� �? �t1 1�C£ 3�-
Secfion No. Township Name or No. Ranpe No. Fire No. CounN .�
Occu nf � Phone No. ^ �
i2.C/►'l f�— � %� � �
Power Supplier Address
C /%1 WnJ d� !S /i.�%r�
Eleclrical Contrac�or (Company Name �� Confmctor License No. Master Lic. No. (Plant Eleci. C
Mailing Address (Conhacror or Owner PerForming Inslallotion) �
� �� Sr�✓� �
Aufhoriz ignatu (Confracfor or Owner Pe mi g Ins afio�) Phone No.
(o ��� �
EB-00001 1�1 /96 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY