P - 82927REQUEST FOR ELECTRICAL INSPECTION
6 2�� �� 1 � 8f21 Uni eSsity A ea,rRm. S-128,ISt. Paul, MN 55104
� Phone (612) 642-0800
, Home Duplex Apt. Bldg. Other: New
Commercial Industrial Farm � �� Remod
Air Cond. Htg. Equip. Water Htr.
Dryer Ra�ge Elec. Heat
"X" above the work covered by this request. Enter
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Mgmt. Other. �
Service
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 Fee # Service Entrance Size Fee # Circuits/Feeders
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Streei Ltg.jTraffic Sig. Above 200 Am s Above 100 Amp;
Transformer/Generator INSPECTOR�s use oN�v TOTAL
SignJOutline Ltg. Xfmr. �
Alarm/Remote Confrol
described herein on the dafes stated
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Fee
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_� Investigative Fee � � �� ��/—�--5—� �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFlCE USE ONLY This request void 18 months From validafion date printed in this box.
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PLEASE PRINT OR TYPE
Request Date Ro Min ins ion r uired$ Yes
ug pecf eq ❑ No Inspecfion Ofher Than Rough-In: eady Now ❑ Will Call
�`�� � (You must call the inspector wh n ready) Date Ready:
I, �licensed confractor ❑ owner hereby request inspection of the above electricol work at:
Job Addres�hee�or Route No. ^ Ciry Zip Code
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SecFion No. Township Name or No. Ranue No. Fire No. Countv _ t .
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rical Co C
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16901 Xylite St.
Phone No.
License No.
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STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY