P - 80927REQUEST FOR ELECTRICAL INSPECTION ��"`
8 O+'— ��� � 8121 Unl ess ry A ear Rm. S1e12r8, ISt. Paul, MN 55104 ���
- Phone (612) 642-0800 -
Home Duplex Apt. Bldg. Other New Addn
Commercial Industriol Farm Remod Re air
Air Cond. Hfg. Equip. Wafer Htr. Locd Mgmt Other:
Dryer Range Elec. Heaf Temp. Senice
"X" above �he work covered by fhis requesG Enfer remarks in this space ond on the back of /he white copy enly.
�.v • r� Y`.'��✓i °"�
Calcufofe Inspecfion Fee - ihis Inspc
Other Fee
Mobile Home Pork Stoll
Sfreef Ltq./Traffic Siq.
ine Lig. Xfmr.
mole Conirol
� Pool
Boom
�n Reques� will not be
# Service Enhance'
0 to 200 Amps
Above 200
INSPECTOR'S IISE ONLY
wi�hout ihe correct Fee:
Fee # Circuits
0 fa 100 A
Above 100
I'm:cected �he elecviml
Fee
,56
F,� � �a�2—S—�/
Investigative Fe
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requesf void 18 monll�s from valldafion date prinfed in Il�ls boz.
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PLEASE PRINT OR TYPE
R�° �O� Ra�gh-in inspeciion requiredi ❑ Yes ❑ No Inspecllon 01hr Than Roog6ln�. g,Ready Now 0 WIII Coll
�s � (Vou most wll the inspecror when reody� Dok Ready:
I, �,licensed confmcbr ❑ owner hereby request inspecfion of fhe above elecfrical work at
Job Address (S�ree�, Box, or Rou�e NoJ City Zip Code
l a(-�715+. w4z ti�, �. F�, d�t -, 5<.ti3a
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Phone No. � � � �
,57,� -
7
rvwning neeress �COnvocroror(TUner PeAorming Installotion)
� � .IS,` s�+1��.J- u. �%7',�S � 3 � �i
Authonzed Slgrwbre �Commcbr or Owner Performing Insmlla�lon Phone No.
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EB-0OOOIA-I 1 8/96 STATE BOAflD COPY - SEE INSTHUC110NS ON BACK OF YELLOW COPV