P - 84571�1 � REGIUEST FOR ELECTRICAL INSPECTION -
`t; ( rr V� 2 3 4■ 8'21 University AB ear Rm. S-�8, St. Paul, MN 55104
Phone (612) 642-0800
kiome Duplex Apt. Bldg. Other: ew Addn
Commercial Indusfrial Farm Remod Re ir
ir C�nd. tg. Equip. Water Htr. Load Mgmt. Other:
ryer • Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on ihe back of ihe white copy only.
Calculate Inspection Fee - This Inspection Request will not be accepled without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 00 Amps / 0 to 100 Amps
Sheet Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOT�
Sign/Oudine Lig. Xfmr. ��, . •
Alarm/Remote Confrol �
Swimming Pool
I hereb certi that I ins ted the elecirical installaKon dexribed Aerein on the dofes stated
Irrigation Boo r - Rou h-io '
S�CIO� �fISpEC .✓ , 9 � Datel �''
9 Firal -' i Da �I �
Investi ative Fee ' t
THIS INSTALLATION 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.
'I 11
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PLEASE PRINT OR TYPE
Request Rough-in inspecfion required? Yes ❑ No Inspection Olher Than Rough-In: ❑ Ready, Now i I Call
�/� ��� �You must call the inspecfor when ready� Date Ready:
I, icensed confractor ❑ owner hereby request inspection of the above elecfrical work at:
Job Address �Sheet, Box, a Route No.l Ci — Zip Code
� `7 $ $TC'-Y� 1J - �Y' l Y�LQ,
Secfion No. Township Name w No. Range o. Fire No. �
.1.� `i�fi.i�-
Occup4n� � � • � Phone No.
I Power
Conhacfor (Company Name� Conhactor License No. Masfer
cmES �.ECrR�c, nvc. cnoo�e�
�ddress (Conk«tor or Owner Pe�i alion
� �
re (C ing Inslallofion) � t� ��,-� Phone I
411 8/96 y.TA� ��p �Y _�E INSTRUCTIONS oN BsGC oF ve��c�w r�fov