P - 80717REQUEST FOR ELECTRICAL INSPECTION
�"���"— � � M821 University A earRm. S-128,ISt. Paul, MN 55104 =
„ Phone (612) 642-0800 `'�'
� Commercial Industrial farm
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
New
Remod
v�hite copy only.
Calculate Inspection Fee - This Inspeciion Request will not be accepted 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
Sfreet Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL�
Sign/Outline Ltg. XFmr. �
Alarm/Remote Conhol
Swimming Pool
I hereb certi that I ins cted the electrical installation described herein on the dates stated
Irrigation BOOm Rough-In ��
$�CiO� �f15p2C}IO '
Final �j _��
Investigative Fee /
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requesf void 18 monfhs from validation date prinfed in this box.
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PLEASE PRINT OR TYPE
Requesf Date Rough-in inspecfion required? ❑ Yes No Inspecfion Ofher Than Rough-In: Ready Now ❑ Will Call
s�9•�99 �You must cali }he inspector when ready) Date Ready: 6� � 9
I, [�licensed confractor ❑ owner hereby request inspection of the above electrical work at:
1ob Address (Shcet, Box, w Rou� No.) City Zip Code
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Secfion No. � Township Name or No. Ranqe No. Fire No. CounN
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Elechiml Confracfor �Company Name)
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Mailing Address (Conhacbr or Owner f
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Authorized $ignature (Conhacfor or Ow
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Phone No��1
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Address
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orming Insfallafion) " (�j Y+j . f o� Phone No.
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)ARD OPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY