P - 77867� REQUEST FOR ELECTRICAL INSPECTION ,�.w ee-0000�_03
T i'�i�3 ��
' See instructions for compleT.ing this form on back of yellow copy. _�����
•""X'; Below Work Covered by This Request
N qdd p. Type of Building Appliances Wired Equipment Wired
Home Range Temporary Service
Duplex Water Heater Lightiny Fixtures
Apt. Building Dryer Electric Heatin
Commercial Bldg. Furnace Silo Unloader
Industriai Bidg. Air Conditioner Bulk Milk Tank
Farm Other pecify Other (SUecifyl
t er SUecifY Other Other
Compute lnspection Fee Below
kt Fee ServiceEntranceSize # Fee Feeders/Subfeeders N Fee Circuits
Oto100Am s Oto30Am s —Z.V Ot�30Am s
101 to 200 Amps 31 to 100 Amps �� 31 to 100 Am s
Above 200 Amps Above 100_Amps (� Above 100_Amps
Transformers Remote Control Circ. .5,� Partial/Other Fee
Signs Speciallnspection
Remarks S � � TOTAL FEE
Rough-in Date
I, the Electrical
Inspector, hereby
certity that the above
Final � /� b Date inspection has been
1/(/��LN� � � C! made.
This request void
18 months from �� �
�—_.---- - � - - -� -- ------__ .. -----_ .�. _ . °
This request void
18 months from
T 73123 =���
Requ st Date Fire No
�� � 3 �3
� Licensed Electrical Contractor
Owner
�' .�r 8� y�
���,n-�„ i�sue�t�
aquired�- ��.� Ready Now I Notffy Inspeo-
� �N tor When Ready
I hereby request inspection of above
electrical work installed at:
Griggs-Midway Bidg. — Room N-191 BE ACCEPTED BY THE STATE BOARD
1827 University Ave.; St. Paul, MN 55104 UNLESS PROPER INSPECTION FEE IS
Phone (612) 297-2111 ENCLOSED.