P - 81038, REQUEST FOR ELECTRICAL INSPECTION
'� �J �� V`t � � 8121eUniversity A earRm. S-128,ISt. Paul, MN 55104 =
3 b / / Phone (612) 642-0800
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Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm 9� Remod Re air
Air Cond. Htg. Equip. Water Htc Load Mgmt. Other.
Dryer Range Elec. Heat Temp. Service
"X" abova t e work covered by this reques�. E ter remarks in this space and on the back of the white copy only.
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Calculate Inspecfion Fee - This Inspection Request will noi be accepted without fhe correct fee:
Oiher 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 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOT�A^L
Sign/Outline Ltg. Xfmr. �/, J�V
Alarm/Remote Control
Swimming Pool
I hereb certi that I ins the elecirical insMllation described herein on the dates stated
Irrigation Boom Rough-In ��e
Special Inspecti
Finol Da�p— �Za�/L
Investigative Fe J
THIS INSTALLATION MAY BE ORDERED DISC ECTED IF NOT COMPLETED WITHIN 18 MONTHS.
� OFFICE USE ONLY This roquest void 18 months from validation date printed in this box.
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PLEASE PRINT OR TYPE
Requesf Date Rough-in inspecfion required$ ❑ Yes �No Inspection Other Than RougMn: �Ready Now ❑ Will Call
� �You musf call the inspector when ready) Da1e Ready:
I, �licensed contractor ❑ owner hereby request inspection of the above elechical work at:
Job Address �Sheef, Box, or Roufe No.) Ci1y Zip C t���
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Section No. Township Name or Na, Range No. Fire No. Counly
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Occupanf � Phone No.
p r/ S /G�C. �l� —��� — �
Power Supplier Address
Elechical Con �acror �Comp ny a� Conhocror License�� Master Lic. No. (Nant Elecf. Only)
(/f% t � � �C/ 1
Mailing A ress (Conhactor or Owner PerForming Installation�
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Authorized Signature �Confracfor or Owner Performing Insfallafio Phone No.
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E A-1 8/96 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY