P - 83224REGIUEST FOR ELECTRICAL INSPECTION - � �
6� L� ���� � 8121eUniversity A ea,rRm. S-128,ISt. Paul, MN 55104
Phone(612)642-0800 "�'
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm emod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
P� ab C.� cc.e�.�� —11-1-7 �� S
Calculate Inspection Fee - This Inspection Request will not be accepted without fhe correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL �h
Sign/Outline Ltg. Xfmr. S�'�
Alarm/Remote Control
Swimming Pool
I hereb certi thaf I ins ected fhe elech'ical insfallafion described herein on ihe dates staled
Irrigotion Boom RougMo Dare
Investigative F r���� � - _ I ��� ��
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 lIAONTHS.
I NN II III N IN I ���E USE ONLY This request void 18 months from volidation date printed in this box.
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* 0 6' S` 8 6 6 2 2* ��a �
PLEASE PRINT OR TYPE
R�1�g� � Rough-in inspection required$ ❑ Yes o Inspecfion Other Than RougMn: ❑ Ready N ill Call
`� (You musi call fhe inspecfor when ready� Date Ready:
I, icensed conhactor ❑ owner hereby request inspection of the above electrical work at:
lob Addreu �Sheet, Box, or Route No.) Ciy Zip Coda
(� (�'�� � ��'�` ��3Z.
Secfion No. Townshio ame or No. RanaP N�. Fire No. G���t� __
i �; ( S
roW�
2- I 2Z3
� Hra. �,'c ��r., iNC. I
Mailing Add n lation)
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Aufhorized Si re(Conk or or ner Performin�insfallafion� � Phone No.
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EB-00001 A-1 1/96 STATE BOARQ COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY