P - 83273REGIUEST FOR ELECTRICAL INSPECTION °"
6 J V- 9? 3� 8121 Universty A ea,rRm. Se128,ISt. Paul, MN 55104 ��`3
• � Phone (612) 642-0800 '�°'
Home Duplex Apt. Bldg. Other: New Addn
Commercial Indusirial Farm Remod Re a
Air Cond. Htg. Equip. Water Htr. load Mgmt. Other: �%
Dryer Range Elec. Heat Temp. Service ^
"X" above the work covered by ihis request. Enier remarks in this space ond on the back of the white copy only.
/o o G,m� ��- /,
� —
`�12��,o-,c- �..P� � � � ���•
Calculafe lnspection fee - Th+s lnspection Requesi wi�e accepied without fhe correct fee:
Other Fee # Servi e Entranc 'ze Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 00 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
TransFormer/Generator INSPECTOR'S USE ONLY TOTAL/ ��p
Sign/Outline Ltg. Xfmr. �� �
Alarm/Remote Conhol
Swimming Poo!
I hareb certi Ihaf I ins ted the elecfrical insMllation described herein on 1he dates slafed
Irriqation Boom c,.,,..w., n„ro
Investigatrve ree — "� 3 (J (� � �--- Q
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 M NTHS.
--� --- -- �----
. OFFICE USE ONLY This requesf void I B monifis from validation dale prinfed in fhis box.
Ill�llllllllllll�i�ll�lllli�llllil�l , 67�
�I�
* 0 6 9 0 9 2 3 8� �USJ`�jr
PLEASE PRINT OR TYPE
Request Dafe � Rough-in inspeclion required$ ❑ Yes ❑ No Inspecfion O�er Than RougMn: Ready Now � Will Cqll
(You must call the inspecfor when reody� Dafe Ready:
I, licensed confractor ❑ owner hereby request inspection of the above elecfrical work at:
Job Address �Sheet, Box, or Route No.� City Zip Code
�l_ S� ,�� Il.�' ,.(�^ ��
Secfion No. Township Name or No. Range No.
Occupant ..
Power Supplier ' � Address
EE PE�N�A������C.Y���t I C. I NC.
ili ress onh • r�r�edoyning Insfailafion�
aon api s. �•r��
Aufhorized Signature (Conhacto� or r PerForminp Ins a nl 1
STATE � D COPY - SEE
v �_�A�i�.oi/`Q�
Phone No. / /��(
��/r�G/UV O
License
�� Phone No.
� '?.� 7 :�C�
ON BACK OF YELLOW COPY