P - 82831REGIUEST FOR ELECTRICAL INSPECTION
6�+J ��J o O � 8121 Uni ess ty A ear Rm. S-128,'St. Paul, MN 55104
�
, Phone (612) 642-0800
Home Duplex Apt. Bldg. Other: New Addn
ommercial Industrial Farm Remod Re air
Air C � Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heot Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
Colculate Inspection fee - This lnspection Request will not be occepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR°s use oN�v TOTAL (� CO
Sign/Outline Ltg. Xfmr. �•�
Alorm/Remote Confrol
Swimming Pool
I hereb certi ihat I ins the elechical instollation described herein on the dates stafed
lrrigation Boom RougMn Dare
$pecial Inspec
FineF- � Dare
Investigative Fee �^� .--e �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
� OFFICE USE ONLY This request void 18 months kom validation date prinfed in this box.
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* 0 6 6 8 9 U 0 4* � 3l°'Z
P EASE PRINT OR TYPE
Request � Rough-in inspecfion required? ❑ Yes o Inspection Olf�er Than Rough-In:
� g� (You must call fhe inspector when ready) Dafe Ready:
I, �censed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sheet, Box, or Route No.� Ciy �
$ �� � V� �1.�L.�
Section No. Townshio Name or No. Ranae No. Fire No. Countv
1 Power
�
i� Conhacfor �Company Name�
�1_ �a�t� ���
Address (Conhacfor or Owner Perfprming Instollation)
/�53�7 �,2n�a� NF
Phone No.
�^ 1 � �
Owner Performing Insfallation� Phone No.
(O�Q �
STATE BOARD C Y- SEE INSTRUCTIONS ON BACK OF YELLOW COPY
Now ❑ Will Call
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