P - 81918REf�UEST FOR ELECTRICAL INSPECTION
6�+� �� v� � in821 Universaty A earRm. Se128,ISt. Paul, MN 55104
Phone (612) 642-0800
Home Duplex Apt. Bldg. Other: j �/� New Addn
Commercial Industrial Farm ��'�( r'd ��°�4 Remod e 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.
6° �-�� ��° � �°,� 'g�,o ���s�
�Q � v� « �/��/��
Calculate Inspection Fee - This Inspection Request will nof be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall to 00 Amps 0 to 100 Amps �
Sfreet Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/GeneraFor INSPECTOR'S USE ONLY T��L `
Sign/Oudine Ltg. Xfmc � TO
Alorm/Remote Conhol
Swimming P
I hereb certi that I ins cted the elechical installation dexribed herein on the dates stafed
Irrigation Boom RougMn , pare
Special Inspection
Investigative Fee F��� ' �� �,/— d�
THIS INSTALLATION MAY BE ORDERED DISCONNE ED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 monlhs From validafion dale prinfed in fhis box.
i N� ii iil ii iil ii iil ii iii ii i�i � iii � m i i �'�° •
�
* 0 6 6 2 7 8 3 0* /�'°�' .����
PLEASE PRINT OR TYPE
Request Date Rou h-in ins on r ui�ed?
g pecti eq ❑ Yes No lnspection Ofher 7han RougMn: ❑ Ready Now ' Call
�l �� � (`/ou musf call the inspecfor when ready� Date Ready:
I, icensed confractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sheef, Box, or Roule No.) City Zip Code
s's� � /�-v� �'� ��` S`s'�(32
Secfion No. Township Name or No. Range No. Fire No. ty , .
vccu n�� � - ' RSone No. � .
�( - 4� o — Sr.3l�
Power Supplier Address
� `�Sr C;�-� �� -
Eleclrical Conkaclor (Company Name) Conhador License No. Master Lic. No. (Plant Elect. Only)
lQ �x �
Mailing Ad reu (Conhacfor or Owner Performing Installafion)
'�-�--,- � L,✓ �J �?�:' �h/ v ��
Aufhorized Si re (Confractor or Owner Pe ing Instollation) Phone No.
: �?,�? a g��C
E A-11 8/96 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY