P - 80848� II ` REQUEST FOR ELECTRICAL INSPECTION ff��...
`II�tI4IlIlItI4IIfIfIflIItIIIiNIIIIIIII{1III�1 1ng21eUnivessty A ea Rmf S128cSt. Paul, MN 55104 ���'
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Hame Duplex Apt. Bldg. Other: New Addn
Water Htr. Load Mgmt. Other:
Elec. Heat emp. Service
requesG Enter 2muks in this space and wr fhe back ot the white ccpy only.
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3lculate ln�eclion Fee - This Inspection Request will not be accepted without the carect lee:
Other Fee � Service Entrance Size Fee x Circuifs/Peetlers
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200_Amps Above 100_Am
Transformer/Generator INSPECTOR'S IISE ONLY TOT,4�
Sign/Outline Ltg. Xfmr. O�
Alarm/Remote Control
Swimmin Po I
Fee
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9 � I ne2by oertity that I inspected 1M1e elecUical installatlon tlescnbed hnain on the da[es sta�etl
Irrigafio Rough-In . Date
Special s F_ ai
Investigative Fee � � Zd �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
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� OFFICE USE ONLY This re9uest voitl 18 months fmm validation date Printed in Mis box.
396-232
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'LEAStttpppEaaa PRINT OR TYPE
e9^Sr� Pouyh-in inspection requiretl? � Yes No Inspection Olher Than Rough-In: Reatly Now Nfll Call
,S.f\
/ IV (1'ou must call �he inspector when reatly) Date peady.
� licensed contractor ❑ owner hereby request inspection of the ab�ve electrical work at:
No.
Narne or No.
o�
Range No.
EB-00001A-11 8/95 STATE BOAqD COPV -
Phone No��y/.�[�
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