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P - 80827RE(�UEST FOR ELECTRICAL INSPECTION 8`t i'� 911 � 8121 Univers � A ea,r Rm. S-12r8,'St. Paul, MN 55104 � Phone (612) 642-0800 Home Duplex Apt. Bldg. Other: New Addn Commercial Industrial Farm Remod Re air Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other: `� Dryer Range Elec. Heat Temp. Service � �e rrBCt�L- "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 accepted without the correct fee: Other Pee # Service Entrance Size Fee # Circuits/Feeders Fee Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps Sheet Ltg./Traffic Sig. Above 200 Am s Above 100 Amps Transformer/Generator iNSPecTOR'S USE ONLY TOTAL s Sign/Outline Ltg. Xfmr. �0' Alarm/Remote Control Swimming Pool I hereb certi that I ins ted the elechical installation described herein on the dales staled �ff19O�lOfi'800 � RougMn Dafe Special Ins Finol D � Investigafive Fee -� d— THIS INSTALLATION MAY BE ORDERED CNSC CTED IF NOT COMPLETED WITHIN 18 MO�iTHS. —.— _—____ _ _ _�i: _ _ -- —_ __ OFFICE USE ONLY This requesf void 18 months from validation date prinfed in ihis box. '� ��N����II��������I���������������� • �o - � * 0 8 4? 9 1 1 5* Z�7a PLEASE PRINT OR TYPE Request Date Rougfrin inspecfion required? ❑ Yes No Inspecfion O�er Than RouglFln: Ready Now ❑ Wi�l Call ��+�9 �`(ou must call the inspector when ready� � Date Ready: I, '� licensed contractor ❑ owner hereby requesf inspection of the above electrical work at: Job Addreu (Street, Box, or �Roule No.) City Zip Code ��zo -� b ie st'n�� Fr�Q�/� $ection No. Township Name or No. Range No. Fire No. Couny �N O /� Occu nr Phone No. �01'► � �► �e r.� S7'f � -!d/ Power Supplier Addr\ s �. Elechical Contractor (Company Name) -- Confracror License No. Masfer Lic. No. (Plant Elecf. Only) ��s E��� � �, k. ,�-a � t� Mailing Address (Conhacror or Owner Performing Installafion) �'l� as7 �' A-�. �u�../-�„�;.., - ss3 9�'' Aufhorized Signature (Conhacfor or Onwner Pedorming Insfalkfionj Phone No. �i0�rsoo . /� 1- ��',9�'�l� . EB4 001 A-1 1 8/96 ST BO D COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY