P - 80630^ REQUEST FOR ELECTRICAL INSPECTION
`�' 0�—�" ` � 8'21 Universty A ea,rRm. S-128,ISt. Paul, MN 55104
Phone(612)642-0800
Home Duplex Apt. Bldg. Other: y� /'� New Addn
Commercial Industrial Farm �/ l v_ Remod Re air
ir Con 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 f the white copy only.
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Calculate Inspecfion Fee - This Inspection Requesf will not be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Cirwits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./7raffic Sig. Above 200 Am s Above 100 Am s
Transformer/Generator INSPECTOR'S USE ONLY TOTAL O
Sign/Outline Ltg. Xfmr. i
Alarm/Remote Conhol
Swimming Pool •
I hereb certi that I ins ted the electrical installation described herein on the dates stated
Irrigation B Ro„9M„ Drne
Special Ins ti n
Final . Da I�
Investigative Fee
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
� OFFICE USE ONLY This requesf void 18 months from validotion date printed in fhis box.
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PLEASE PRINT OR TYPE
Requesf Date RougMin inspecfion required$ ❑ Yes o Inspecflon Other Than RougMn: dy Now 0 Will Call
��„ � (You musf call fhe inspecfor when ready� Date Ready: �.
I, licensed contractor ❑ owner hereby requesF inspection of ihe above electrical work at:
Job dre �Sheet Box, or te No City Zip C
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Secfion No. Township Name w No. Range No. Fire No. Counly �^ _
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Occupanf Phone o.
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Power Su plier Addre
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Elechi on��pan _ame Confrador{icense No,�� Mast� L, ic� No. (Planf Elect. �
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Mailing d � ress (Conhacfor or er PerFormin Insfallation� � ( , � 4 I ,' ,� ` � �/�
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Authoriz Si nafure (Co acfor o ner Performing In Ilafion) Phone Ncy i�' 1�., /J/�
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E&000 1 A-11 8/96 pTE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY