P - 80940�7 RE�UES OR ELECTRICAL INSPECTION `�
�� � r T�� � 8'218Univ rs(ty A e�,rRm. S-12r8,'SL Paul, MN 55104 k��� .
- Phone (672) 642-0800
u,.,,,e n��,.lA„ Ao� eldo. Othec New Addn
Air Cond. -H�g Equip. Water Htr. Load Mgmt. Other.
Dryer Range Elec. Heal Temp. Service
"X" above fhe work covered by fhis requesG EnQfer �rem�arks ryin t�his space and on the back of /he whi�e copy only.
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Calculate Inepecfian Fee - This Inspxtion Request wi(1 not be oc<epted withouf /he <orrecf fee:
Other Pee n Service Enhance Size Fee # Circuits/Feeders Fee
Mobile Home Pork Smll 0 to 200 Amps 0 to 100 Amps
Street Ltg.(Tmffic Sig. Above 200 Am s Above 100_Amps
TrnnsFnrmer/Generabr INSPECTOR'S USE ONLY TOTAL �
I hereb cern that I I�s ecled the elenriml Instollation described herein on ihe dc
e.,��„h.lo Dote
Invesliyafive Fee '��'�'� —� Q
THIS INSTALLATION MAY BE ORDERED DISCO ED IF NOT COMPLETED WITHIN 18 MONTHS.
OFPICE USE ONLY Thls requefiwid IS monihs hom validalion dme prin�ed in �his boz.
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PLEASE PRINT OR TYPE
Reqoest Dote Roigh in inspecnon � -�z
eqwr ❑ Yex No Inspecfion OMer Than Ragh�ln: ❑ Reody Now III Coll
� 1— (Vev m�si mll the ��epe<t« when ready� �ore Ready:
I, licensed confroctor 0 owner hereby request inspecfion of rhe obove elechicol work at:
lob Address Isrear, eo., « eo�r� No.l . r�, .. ,. ,
.t t� G l c'� �t. ►�,1 Z� I t-r? dLl2�V I SSy'�Z
N T h p N r Na. Range No. Fire No. Counro
Occupani ��
Vower Sun�l�e.
BLAINE HTG. A, C ELECT., WC.
, i ro�� �G'i
ANO FI!N 5�:?�4
more �C nho o Owner Pedorming Insmllofion�
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