P - 82766� �� REQUEST FOR ELECTRICAL INSPECTION
� J�� O V V � 8121 Uni eSsty Ave.,rRm. S-128,ISt. Paul, MN 55104
Phone (612) 642-0800 " '
ome Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod e air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Ran e Elec. Heat 7emp. Service
"X" above the work cove�ed by this request. Enter remarks in this space and on the back of the white copy only.
s�vlc,� uP�Fi r��-
Calculate Inspection Fee - This Inspection Request will not be accepted without the correcf fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stoll 0 to 200 Amp S 0 to 100 Amps
Street Ltg./Traffic $ig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR�s use oN�r TOTAL ��
Sign/Outline Ltg. Xfmr.
Alarm/Remote Confrol
Swimming Poot � '� I hereb certi ihaf I ins fFe elechical inslallafion described herein on the dates slated
Irri9ation Boo RougMn Dafe
Special lnspection
Final Dat
nvestigative Fee - L=�
THIS INSTALLATION MAY BE ORDERED DISCONNEGTED IF NOT COMPLETED WITHIN 18 MONTHS.
_ _ OFRCE tISE ONLY This requesT wid 1 S months from validation dafe prinled in this box.
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PLEASE PRINT OR TYPE
Request Date Rough-in inspecfion required$ ❑ Yes o Inspedion Other Than RougVrin: ❑ Reody Now�ill Call
.�. 2U � �You musf call the inspecfor when ready) Date Ready:
I, �'rensed confracror ❑ owner hereby request inspection of the above electrical work at:
Job Address �Street, Box, or Route No.) Ciy Zip Code .
S
Section No. Township Name or No. Ra�ge No. Fire No. County
Occupant Phone No.
Power Supplier Address
�
Electrical Conhacfor ompany Name� Conhactor License No. . Masfer Lic. No. (Planf Elecf. Only)
�
Mailing Address (Conhacfor or Owner Performing Installation)
�
Authorized ture trador or Owner Performin nstallaf n) • � � Phone No.
E 1 A- 1 8 96 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY