P - 82066� REQUEST FOR ELECTRICAL INSPECTION --: s
8'�t O-� 9 9 5� 8121 Univers � A ear Rm. SI 128, ISt. Paul, MN 55104 �
.
Phone (612) 642-08Q0 '��
Home Duplex Apt. Bldg. Other: ��Q /� `�2.�."�i i� �� New Addn
Commercial Industrial Farm R Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other: `'
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
Calculate Inspection fee - This inspection Request will not be accepted wi►hout ihe correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall to 00 Amp 0 to 100 Amps
Street Ltg./Traffic $ig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR�s use oN�v TOTAL �
r�
Sign/Oudine Ltg. Xfmr.
Alarm/Remote I
,
Swimming Pool � (
I hereb certi that I ins ted fhe elechical installation described herein on the daMs smted
Irrigation Boom RougMn Date
Special Inspection
Find ' D
Investigative Fee �'
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITFjI�I 1$ MO TN HS _
OFFICE USE ONLY This request roid 18 months from validafion date prinfed in ihis box.
Illililllllllllllllllllllll�lllllillllllli� � �. �
*0840995s* 0?3��
PLEASE PRINT OR TYPE
R uesf Dafe Roogh-in inspecfion required$ ❑ Yes o Inspection Ofher Than Rough-In: ❑ Ready Now Will Call .
� 2C"�'�2� �You musf call the inspecfor when ready� Dafe Ready:
I, L7licensed conhactor ❑ owner hereby request inspection of the above electrical work at:
Iob Address (Sheet, Box, or Roufe No.) Ciy Zip Code
No. � Township Name or No. � Range No. � Fire
� OccupaM
Signature
or Owner
Phone No.
{A'�c ]���( %
�
No. Master Lic. No. (Plant Elect.
!
'� Q � �
Phone No.
�� �Si?7�AiyCT�� ._ I�
STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY