P - 83310REQUEST FOR ELECTRICAL INSPECTION -
- 7 01 � in821 University A ear R nf Se12$ ISt. Paul, MN 55104 �`
���� Phone 12 64 -
r/Q o F7O1 (6 ) 2 0800
lf� �
Home Duplex Apt. Bldg. Other: ew Addn
Commercial Industrial Farm Remod Re air
Air C tg. E uip, Water Htr. Load Mgmt. Other.
Drye Rang Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in Ihis space and on the back of the white copy only.
Calculote Inspection Fee - This Inspection Request will nof be accepted without the correci fee:
Other Fee # Service Entranc Siz Fee # Circuits/Feeders Fee
Mobile Home Park Stall to 00 Amp 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
Sign/Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
I hereb certi thot I ins ted the electrical installation described herein on the dates stated
Irrigotion Boom RougMn r1 � oare
Speciallnspect "'� � S—
Final
(nvestigative Fee " � 7� �
THIS INSTALIATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validation date printed in ihis box.
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* 0 6 7 8 7 0 1 4* �S-�
PLEASE PRINT OR TYPE
R� �O� ^� Rouglfin inspection required? Yes ❑ No Inspecfion Other Than Rough-In: ❑ Reqdy Now Will CaN
��� �`/ou musf call the inspecfor when ready) Date Ready:
I, licensed confracror ❑ owner hereby request inspection of the above elechical work at:
Jo�+.4ddre•• " •^ or R ) Ciy Zip Code
. �'j ����' �-�
Seclion No. �'�..wna��ip Name or No. Range No. Fire No. Co�n
Phone No.
Electric6l Conkacfor �Company Name) Conhaciw License No. Master Lic.
CITiES ELEC7RIC, INC. CA00381
Maiting Address (C 1 � ' 0 '
� •
Authorized SignaNre � Ila ���� Phone No.
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EB-00001 A-11 8/96 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY