P - 81051REQUEST FOR ELECTRICAL INSPECTION -
��`� � 214 � 8121 Universty A earRm. S-128,ISt. Paul, MN 55104 �`
Phone (612) 642-0800 '��'
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial farm Remod Re air
Air Cond. Htg. Equip. Water Htr. Load M mt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this req�est. Enter remarks in this space gnd on the�� � � t e white copy only.
f<� 1-� �,t.�.t.
��,, ��
t� S�-1�`t= � ggs
Cakufate Inspection Fee - This lnspecfion Requesf will not be accepted wilhout the corcect fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stoil 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPEC70R°S USE ONLY TOTAL �
Sign/Outline Ltg. Xfmr.
Atarm/Remote Co�trol
Swimming Pool
1 here certi ihot I ins the eleclrical installation described herein on the dates stated
Irrigation oom RougMn Dare
Speciall '
F�� �_
Investigative Fee
THIS INS7ALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTH .
OFFlCE U8E ONLY This request void 18 months from validation date printed in fhis box.
i��ii«I�iiii�i�i�����it����il�i���iiiii ! �.�
� 0 8 4 0 C 1 4 1* � l��
PLEASE PRINT OR TYPE
Request Dafe Rou h-in ins q p g ❑ Ready Now ill Call
+��� � g pc�ction re uired$ ❑ Yes No Ins eciion Other TAan Rou Mn:
(You must call tl�e inspector when reody) Date Ready:
I, licensed conhactor ❑ owner hereby request inspection of the above electrical work at;
lob Address �Sheet, Box, or Route No.) � Ciy Zip Code
�t !�d -�rr`c�.��. ��U�a
Secfion No. iownship Name or No. Range No. Fire No. Couny ��^�'�r����
Occupant Phone No,
G�-i.,�'� � -��- �'71- g 0 �
Power Supplier Address
Elachicnl Ca�hacror (Company Name) Conh or License No. Master Lic. No. (Plant Elect. Only�
Bl,�II�E HTG. A, C ELECT., iNC.
Mailing Address jContrac :01. @ p�ingr �I a ion
V
ner Perforryjrig Insfallation� Phone No.
���� G�V O
STATE BOARD COPY - SEE INSTRUCTIONS OM BACK OF YELLOW COPY