P - 80926r REQUEST FOR ELECTRICAL INSPECTION '""�
8�° �_�" O � 1ng21eUniversa� A ear Ro� SedrB i$t. Paul, MN 55104 ��'�,
_. Phone (612) 642-0800
r
Home Duplex Apt. Bldg. Other: , New Addn
Air Cond. Hfg. Equip. Wofer Htr. Load Mgmt Othec
Dryer Range Elec. Heaf Temp. Service
"X" above �he work covered by �his request En�er remarks in tfiis space and on Hie back oF �he
P�p�'j C�0,�1-��11
j451= t1-1-1 �b`�5
Calculafe Inspecfion Fee - This Inspec�ion Requesf wil) nof be accep�ed withouf lhe mrrecf fee:
Other Fee # Service Enhance Size Fee # CirCUits/
Mobile Home Park $mll 0 ro 200 Amps 0 fo 100 Ar
Sfreei Lfg./Troffic $ig. Above 200_Amps Above 100_
Trnns{nrm>r/Gwnwminr INSPECTOH'S USE ONLV
rhe elecrcical
copy
Fee
�.
THIS INSTALLATION MAY BE ORDERED OISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This reqoesf void I B monihs fmm valldolion dala prinkd in ihls box.
��A�� �� �� (�� ��I� ��� I�l�ll�l{����� ���N�I � aD.Sd
* 0 8 L 7 4 6 0 9 x `�34�
PLEASE PRINT OR TYPE
Req�e:� Date RougMin �nspenion requiredE ❑ Yes No Inspeciion Oiher ihan RoogMin: ❑ Ready Now ill Call
�You must mll �he inspxbr when ready� Dale Reody:
I, licensed coNmcfor 0 owner hereby requesf inspecfion oF ihe above elecfrical wark at:
bb Address ISheeY, eox, or Raire Np.l CiN _ .. Zio Code
J
Occupanll
Power Sup
Phone No.
ELECT., iNG
3Z
IL�.t1�1n�,��c.j1 I "l5'f-(D2.o-v
STATE BOAN� COPV - SEE INSiRUCTIONS ON BACK OF YELLOW COPY