P - 82051• REQUEST FOR ELECTRICAL INSPECTfON ��_•
`�° `' � 0 y"`�' � g121eUniversty A earRm. S-12r8,'St. Paul, MN 55104
� Phone (612) 642-0800 `'�'
ome Duplex Apt. Bldg. Other: N w Addn
Commercial Industrial Farm emod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heaf Temp. Service
"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 Fee # 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 Amps Above 100 Amps
Transformer/Generator INSPECTOR�s use oN�r T TAL� rn
Sign/Outline Ltg. Xfmr. �`�a- �''�`�� ��� I� �/
Alarm/Remote Conhol �� a ! �g _ � �C67� i �j,•/a-t—a/
Swimming Pool �
I hereb certi that I ins the electrical installation described herein on ihe dares sfafed
irriqation Boom n 1'f � A ea�eha� Dare. , _
Investigative Fee �� I ��/C�C�
THIS INSTALLATION MAY BE ORDERED QISCONNECTED IF NOT COMPLETED WITHIN 8 MONTHS.
OFFICE USE ONLY This request void 16 months from validafion dafe printed in this box.
i ii�1 ii iil ii iii ii iii ii iii si ii�i ii� ii iii �� • a° -�
* 0 8 0 2 1 8 8 3* p2036
PLEASE PRINT OR TYPE
Request Date Rough-in inspection rec{uired? ❑ Yes o Inspection Other Thon RougMn: ❑ Ready Now ❑ Will Call
�' �� �� (You m�sf call the inspector when ready) Dafe Ready:
I, •❑ licensed conhactor ❑ owner hereby request inspection of the above electrica� work at:
lob Add�ssltreet, Box, or I�ite No.�� Cit�^ �� Zip Code �
or
Phone No.
�� O�
Power Supplier
Elechicol CoMraMor f� �ny Name) Conhacfor License No.
I.X�L.C?�C�-�
Mailing Addresrlfiowfractor or �1y�Al'JP tallafion�
l ' �i �
SignaNre (Conhactor or Owner
1 8/96 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY