P - 80446REQUEST FOR ELECTRICAL INSPECTION t«°'£
�o��`— �" � 1^821 Universty A ear R pf SIe12$ ISt. Paul, MN 55104
' �:
Phone(612)642-0800 "�'
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm 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. Enier remarks in this space and on the back of the white copy only.
Calculate Inspection Fee - 7his Inspection Request will rot be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to i00 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer�Generator INSPEC70R'S USE ONLY TOT
Sign//utline Ltg. Xfmr. � �� �
Alarm Remote Confrol
Swimming Pool
I hereb certi that I ins ected the elecfrical insfallation described herein on the dafes stated
Irrigation Boom Ra„yh-i� Dote
$pecia) Inspection � l�' �
Final �. ,C
Investigative Fee ���7
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WtTHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validafion dqie pri�fed in this box.
I�II Il III II III II III II III II Ill li ill II �I � I� I�i
* 0 8 0 2 2? 8 2* �� 5 7�� ,l��S'Q
P�EASE PRINT OR TYPE
Request Dafe R h-in in tion r uired2 Yes
^ oug spec eq ❑ No Inspection Other Than Rough-In: ❑ Ready Now Will Call
/� �/ Q/ (You musf wll the inspector wh ady) Dafe Redly: �
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I, ❑ licensed contractor lldowner hereby request inspection of the above electrical work at:
Job Addreu �Street, Box, or Route No.� Ciy Zip Code
/ - S r`� � �� S a
$eciion No. Township Nome or No. Range No. Fire No. ounty
3a a w�
Occupant R � . Phone No.
� � ,� �l E.E1r � � Yvb;�� �6 .. j
Power $upplier � . Ad ress � �
� G. t� E�!' �1J. s li /3 U S /�'� �.5 �l/�v y� [i
E eckical Conh tor �Company � Confracto� License No. Masfer lic. No. (Plant Elecf. Only)
Mailing Address (Con w Owner Performing Installation)
Autho Signalure (Conh or r erFo ing Insfallation� Phone No.
� S�A�a o
EB-0OOO�A"� � 8�9 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY