P - 83543REQUEST FOR ELECTRICAL INSPECTION - �
5� V, � 916 � in821 University A ea,rRm. SI 128,IS2. Paul, MN 55104
L� Phone (612) 642-0800 '�'
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Re air
' Cond. tg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above ihe work covered by this requesi. Enter remarks in this space and on the back of the white copy only.
� �� _ �
�� �
�
Calculate Inspecfiort Fee - This Irrspection Request will not be accepted wifhout the correci fee:
Other Fee # Service Entrance Size Fee # Circtirts/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Sheet Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTA J"�
Siqn/Oudine Lta. Xfmr. ��.� V
� Pool
I certi �hat I i the electrical installalion described herein on �he dares skded
BOOm - RoupMn �
�..e..�:.--; .�-�
Investigative Fe� �' i i� `) ..T ` - - —2-@r.P.�cS
THIS INSTALLATION MAY BE ORDERED DISCONNECTEO IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months 6om validaficn dale prinfed in ihis box.
�H���������������������� �����������
• �5=5�
* O S L 8 9 L(a 2* PLEASE PRINT OR TYPE ����
Requesf Date Rough-in inspecfion required$ ❑ Yes No tnspecfion Olher Tlwn RougMn: eady Now ��II Call
/ � (You musf call the inspector when ready) Date Ready: �
f, �licensed conhactor ❑ owner hereby request inspection of the above electricol work at:
!ob Address (Skeef. Box, or R__ Np.) ���� Cdy�//� Zip Code
�[ ���
Seclion No. Township Nome w No. Range No. Fire No. Couny �� �
�
a
Phone
Masfer
mon� Fr' �' i J 1�'..� I/C/`� �
- SEE INSTRUCTIONS ON BACK OF YELLOW COPY