P - 83270REQUEST FOR EL�CTRICAL INSPECTION �°`��
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6 Q�c�.1 = 916 � 8+21 Univers � A ear Rm. SI 128,'St. Paul, MN 55104 ��, %
Phone (612) 642-0800
Home Duplex Apt.8ldg. Other: New Addn
Commercial Industrial Farm Remod Re air
Air Cond. Htg. Equip. Water Hh. 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.
Calculote Inspection Fee - This Inspi
Other Fee
Mobile Home Park Stall
Sheet Ltg./Traffic Sig.
Tro nsformer/Generator
Sign/Outline Ltg. Xfmr.
Alarm/Remote Conhol
Swimming Pool
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(n Request will nof be accepted without the correct fee:
# Service Entrance Size Fee # Circuits
0 to 200 Amps 0 to 100 A
Above 200 Am s Above 100.
INSPECTOR'S USE ONLY
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I hereb certi that I ins the eleclrical insfallotion dexribed herein on the dales sfated
Irrigation Boo Ro�gM� oare
Speciallnspe ' r°'
Fil�d Da
Investigative Fee � r- 2�'•- o�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MOMTHS.
OFFICE USE ONLY This requesVvoid 18 monfhs from validation date printed in this box.
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PLEASE PRINT OR TYPE
Request Date Rou h-in ins ion r uired$ ❑ Yes
g pecf eq ' ❑ No Inspecfion Other Than RougMn� Reody Now 0 Will Call
'�� '�� (You musf call the inspector when ready) Date Ready:
I, licensed contractor ❑ owner hereby request inspecfion of the above electrical work at:
10 Addreu (Sheef, Box, or Ro No.) City � Zip Code
3 � 3�
_ on No. Township Name or No. ange No. Fire No. Couny '^ /
� Power
Address
INC.
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ni�g lnstallation)
Phone No.
57��13�4
C License No. Master Lic. No. (Plant E6
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Phone No.
- SEE INSTRUCTIONS ON BACK OF YELL -