P - 81315REQUEST FOR ELECTRICAL INSPECTION
��- 4 4 4� 8121eUnivessary ABearRm. Se128,'SL Paul, MN 55104 ���
Phone (612) 642-0800 m�.�
Home Duplex Apt. Bldg. Other. New Addn
Commercial Indusfrial Form Remod Re air
Air Cond. Hfg. Equip. Water Hfr. Lood Mgmt Other.
Dryer Range Elec. Heaf Temp. $ervice
"X" above �he work covered by 1Fiis requetG Enler iemorks in /his s ace ond on fhe back of d�vhite copy only.
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Ca/culafe Inspecfion Fee - This Inspection Requesf will not be occepred wifhw� the correct fee.
Other Fee # Service En(ranc ize Fee # Circuits/Feeders Fee
Mabile Home Park Slall � 0 l0 00 Amp ,OQ 0 fo 100 Amps
Slreet Lig./Tmffic Sig. Above 200_Am s Above 100_Amps
Transformer/Generator �NSPECTOWS USE ONLY T�A� ��O
. Sign/Oulline Ltg. Xfmr. �� �����
Alarm/Remofe Conlrol
Swimming Poo� I hereb ceni ihoi I �ns e�ied the elecmcal ��siallorion descr�b d here�� on �he dares smad
Irri9afion Boam Raugh�ln Oo�.e
$peciallnspec ' n ' }
Finol ale �, y�
Invesligafive Fee /
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE pNLY This requeN vdd I B months 6om validotion dole primed in this 6ox.
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s 0 6 6 2 4 4 4 9* ���
PLEASE PRINT OR TYPE
Reqoes� Data Rough In inxpedion required2 ❑ yes �o Inspec�ion Other Thon Naugh In: Reody Now � Will Call
S—/ �— 99 I�oa m�sr cvll ihe ��specror when �eady� Dore Feody
I, �licensed contmctar ❑ owner hereby request inspection of fhe above electrical work af:
Job Address (Stree�, Box, or Rqy� No � City 2ip Code
- 66.r= I.vfti N,�. ���o S�'i32
Section No. Township Nomc or Na. Range Nn Fire No. Couny
,4N0
�����R��7 !#o���i Ph6iz-s�y-3YlS
Power Supplier Address
i�s M ts _
Elxhical Co onor �Company Namel Conrcoc�or License Na. Master lic No. �Plvm Elen. Only�
f,�lGl�7� �7.Ezll� z/�., c aoo s 2�
Malll�g Addre:s (Conimcqr or Gr-0erforming Insmllanon� J� ���
� YOT� . N,�e I � �' MN.
Aulhai Signalure �Conimdar or Gracyerfar - allofi Phoire No.
�.�.. � 's`' ii f 'i 6/Z— a�SB—��
EBOOOOIA-1 I B/96 STATE BOABO COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY