P - 82296� REQUEST FOR ELECTRICAL INSPECTION
O�� _' 216 � 8f21 Univers� A ea,rRm. S 128,ISt. Paul, MN 55104
Phone (612) 64 8
ome Duplex Apt. Bld . Other 6 �--� New Addn
Commercial Industrial Farm emod Re air
Air Cond. tg. 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.
Calculate Inspection Fee - This Inspection Request will not be accep►ed 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
$treet Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR�s use oN�r TOTA�/ ��
Sign/Outline Ltg. Xfmr.
Alarm/Remote ConMol
Swimming Pool
I hereb certi that I ins the elechical installafion dexribed herein on the dates stated
Irri9ation Boom RougM� Dare
Special Inspecti
Final �
Investigative Fee
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requesf void 1 s f al� a' dafe printed in this box.
i i��i ii iil ii ii� �i iii ii iii �i iii i� �i ii in i iiii �
* 0 8 0 2 2 1 6 2* �" ���
P EASE PRINT OR TYPE �
Requesf Date Rou I�in ins ecfion r �ired$
g p eq ❑ Yes No Inspecfion O�er Than RougMn: ❑ Ready Now ill Call
�'�3^�J"'a (You must call fhe inspeclor when ready) pafe Ready:
I, ❑ licensed contractor I�owner hereby request inspection oF the above electrical work at;
Job Addreu (Sheef, Box, or Route No.) City / Zip Code
�/•Z� ':� ti Q.a�O ��i i r l�%� ��+'d�/!�'` y J�3 'i� L�
Secfion No. Township Name or o. Range No. Fire No. County .
�o �y a r�4,
Occupant Phone No.
/fcna��l /� S`�v�neo.? 7G3-�7/-�7�
Power Supplier Address d� �
NSP �fliJ .o ..� ..r � • T�
Elechical Conhacfor (Company Na � Conhocfor License No. Master Lic. No. (Planf Elecf. Only)
�.. n c,i c�
Mailing Addre�Conhacbr or Owner Performina Insfallafionl
or Owne�� Installation) I Phone No.
a-T/—�78'fo+
STATE BOARD COPY - SEE INSTRUCiIONS ON BACK OF YELLOW COPY