P - 83306� REGIUEST FOR ELECTRICAL INSPECTION °"
6 f'��! O� � 8'21 Universaty A ear Rm. S-128, ISt. Paul, MN 55104 ��'
Phone (612) 642-0800 `��
Home Duplex A t. Bldg. Other: New Addn
Commercial ndustrial Farm Remod Re air
Air Cond. tg. Equi . Water Hir. Load Mgmt. Other:
Dry � ange Elec. Heat Temp. Service
"X" abov the work covered y this request. Enter remarks in this space and on the back of the white �opy only.
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuifs/Feeders Fee
Mobile Home Park Stall o Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOT/�„ ��
Sign/Outline Ltg. Xfmr. �
Alarm/Remote Control
Swimming Pool ��a.� �"
I here certi tfwt I ins the electrical installafion described herein e stated
Irrigation Boom Roo,qMo pore
Special Inspecti Jw� r°`Z�— 5'�
Final Du
Investigative Fe � ,�.�
THIS INSTALLATION MAY BE ORDERED DISCO CTED !F NOT COMPLETED WlTHIN 18 MONTHS.
_ OFFICE USE ONLY This request void 18 monfhs from atio daie printed in fhis box.
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I�I�i�ll III II III II III I IIII
* 0_6 7 8 7 0 5 5* � S��
PLEASE PRINT OR TYPE
Request Date Ro h-in ins on u�red$ es
!� u9 pecli req ' ❑ No Inspection Other Than RougMn: ❑ Ready Now Will Call
��,J 3 � (You must call the inspeclor when ready) Date Ready:
1, licensed confractor ❑ owner hereby request inspection of the above elechical work at:
Job Address (Sh� � or Route No,) � � A City �� ` , n Zip Code
1 � /�
No. I Township Name or No. ' ' Range No.
Phone No.
�ior (Com n Name� Confracfor License No. Masfer lic. No.
C�TIE�S ELECTRIC, MIC. C�4003 1
310G-2�ST�i 3T. W.. �t TN MN SSA
�Conkactor or Owner PerForming Insraq@�ao$810
w �
Nre � n acror or ner e i lotion, 2 6 5� 3 Phone No.
'96 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY