P - 81214REQUEST FOR ELECTRICAL INSPECTION �
`�f �_ o O� � 8121eUniversity A earRm. Se12r8,ISt. Paul, MN 55104 - 3
Phone(612)642-0800 " '
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm x 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.
/, s'�iediG� U,�.eA,e�E,
Calculate Inspection Fee - This Inspection Request will noi be occepted without the correct fee:
Other Fee # Servi e Entran ize Fee # Circuits/Feeders Fee
Mobile Home Park Stall ! 0 to 00 Amp �/�]' 0 to 100 Amps —
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR•s use oN�r TOTAL
Sign/Outline Ltg. Xfmr. J�, S
Alarm/Remote Confrol
Swimming Pool
I hereb certi that I ins the elecirical i�sfallation described herein on the dates stated
Irrigation Boom RougMn Date
Special Ins ti " �'
Investigative Fee � �O�L _/z� a �
THtS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
. OFFICE USE ONLY This request wid 18 months from validation date printed in this box.
iiooiiiiiliiiiiliiiiiiiiiiiiil�i�nmi� • �5p'�
* 0 8 2 0 0 0 4 0* 7S3d
PLEASE PRINT OR TYPE
Request DaTe Rough�in inspeclion required? ❑ Yes �1Jo Inspecfion Other Than RougMn: �Ready Now ❑ Will Call
/! Q%a� g 9 (You must call the inspecfor when ready) Date Ready: �� a 4/�
I, ❑ licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address �Sheef, Box, or Route No.� City Zip Code
� T'—� ST �� sC/1/O ����
Seclion No. Township Name or No. Range No. Fire No. Coun
Occupanf � phona No.
�RA �' .y o - �7' - a� 9
Power Supplier Address
/�ls� ���5_ �tJ /"/NT
Eleclrical Contrac�or (Company Name) Conhactor License No. Master Lic. No. �Plant Elecf. Only)
,D b' / 2 aS l
Mailin Address �Conhacfor or Owner Performirg I�stallaKon)
•��, `!�3 i`�l ��
Authoriz ignaNre (Conh r or ner Pe ng Insfallafion) Phone No.
< < � � �?9�= �a
E&OOOOIA-11 8/96 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY