P - 81900- REQUEST FOR ELECTRICAL INSPECTION �
CJ 4�/ �� 2 6 3 � 8121 Universty Ave ,rRm. S-12r8,ISt. Paul, MN 55104 �
Phone(612)642-0800
'Home Duplex Apt. B{dg. Other. / d Q � New Addn
Commercial Industrial Farm Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgm . Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
Calculate Inspection Fee - This Inspection Request will not be acce
Other Fee # Service Entrance Size
Mobile Home Park Stall to 200 Amps
Sheet Ltg./Traffic Sig. Above 200 Am
Transformer/Generator INSPECTOR'S USE ONLY
Sign/Oudine Ltg. Xfmr. �Gi��•�
without the correct fee:
Fee # Circuits/F
0 to 100 A
Above 100
Fee
_3l-S�
Swimming Pooi �
' I here cedi thaf I ins fhe elechic inslallafion dexribed herein on fhe dates stafed
Irrigation Boom � RougMn
Special Inspection �� �
Firwl
Investigative Fee — �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request wid 18 months from validation date printed in this box.
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� 0 8 0 2 2 6 3 4* �j /. 50
PLEASE PRINT OR TYPE
Requesf DaFe Rouglfin inspecfion required$ ❑ Yes No Inspecfion Other Than Rough-In: ❑ Ready Now Will Call
��� y� U ' (You must call the inspector when ready) Date Ready:
I, ❑ licensed conhactor�owner hereby request inspection of the above electrical work at:
Job Address (Shcet, Box, or Rou�e No.) Ciy • Zip Code
5- 3a 6��- i1. �• 5-.� �.� Z
Seclion No. Township Name or No. Range No. Fire No. unty
Oc+c�panf �
lv %A/ ,� a � USf}i�'� � A N d 1
Power Supplier Address
,� � �
EI ical Conhacfor (Company Nome) Conkacfor License I
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Mailing Address (Conhacror w Owner Performing Insmllafion)
or Ownar
Phone No. � � +0 /
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1 8/96 " a g7ATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY
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