P - 80896p REQUEST FOR ELECTRICAL INSPECTION
�-t7��-683 � Mg2lUniveSta�AearRm Se�2g'St.PauI,MN55104
- Phone (612) 642-OB00
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Home Duplez Apt Bldg. Orher: New
Commercial Indushial Farm Remoc
Air Cond. Hlg. Equip. Water Hfr. Load Mgmt. Ofher.
Dryer Range Elec Heai Temp. $ervice
"X" obove rhe work covered by �his request. En/er remarkUs�io tF'��.s .space �on fhe back oi fhe white copy
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Calculate Inspec�ion Fee - 7his Inspec�ion Requesf will no/ be accepred wiihout ihe <orrect fee:
Other Pee S Service Enhance Size Fee # Circuits
Mobile Home Park Sfall 0 to 200 Amps / 0 to 100 A
Sfreef LIg.JTroffic Sig. Above 200—Amps Above 100
Trnnsfnrmar/Cenerntor INSPECTOR'SUSEONLY
,har i ��,oeaed �ne ei�n�<ai m��nor�o� da,«� d� ��� o� ae(da�e, ,�
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Fee
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� THIS IN6TALLA710N MAY BE ORDEREU DISCONriECTEU IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requesf void 16 months Fom mlidation dale prinled in this 6ox.
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PIEASE PRINT OR TYPE
Reqoe:� Dote ^ Roughin inapedion �eqoired? Yes [] No Inspecflon OtherThan RooghAn: ❑ Ready Now WIII Call
—��'7 �Yau musl mll the inspec�w when reody� Dote Ready:
I, �licensed tantractor � owner hereby requesl inspection of the above elechical work at
Job Address �Sheer, Box, or Rome No.� Ci P
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Secrion Na. Township Name or No. Rnn�u No. F�.o ni,. �.... ..
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o�.,�e. P�.����e i�,�anmm�l.. �172 5 3 P No.
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5fATE BOMD COPY - SEE INSTHUCTONS ON BACK OF YELLOW COPY