P - 79817REQUEST FOR ELECTRICAL INSPECTION
� V�- 3 8 3� 1n821 University A earRm. S 128,ISt. Paul, MN 55104
Phone(612)642-0800
Home Duplex Apt. Bldg. Other: New ddn
Commercial Industrial Farm � �emoci Re air
Air Cond. Htg. 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 o��the back of fhe white copy only.
r-e.,. �`
�� 'a -'��
Calculate Inspection Fee - This Inspection Requesf ill noi�be a, epte�wi►houf the correct fee:
Other Fee Service ntra e Siz t�e # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 mps 0 to 100 Amps
Street Ltg./Traffic Sig. ve 2 Am s Above 100 Amps
Transformer/Generator INSPECT •S us oN�v TOTAL (%�
Sign/Outline Ltg. Xfmr. F �'"� ��~ ��'J�/
Alarm/Remote Conhol v � !E �� �t�- �- Q3 �
Swimming Pool
I here certi Ihat I ins the electrical installation described herein on the dates stated
Irrigation Boom Rw�gMn oar�
aa ��� a3
Special Inspection _ ��
Fi�wl Da
Investigative Fee
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
■ ---
■ ..__..._ ..-- --•• •• -. . . . _ . . . . '
I I��I II I�I II III II III II III II �II II I�I II III II ��I I II�I �' , r
* 0 8 0 2 3 8 3 0* ����
PLEASE PRINT OR TYPE � �sv
Request Dale Rn Irin ins lion r uiredi Yes pe g ❑ Ready Now ill Call
`�9 P� eq ❑� Ins clion Other Thon Rou h-In:
�� 3� O 3 �.: musl call Ihe inspector when ready) � fe Ready:
I, ❑ licensed contractor �owner hereby request inspection e abov electrical work at:
lob Address �Skeet, Box, or Rou �No.) Ciy '' Zip Code
Sovo C lr�arul a�,,,, N ' d' ' S S 4Z �
Section No. Township Name w No. J. . ang �. e N ou ly
'�j ' Z. �no k�
, ;
Octupanf � '�•,, ! y Phone No.
L0.t�r��iaavl '`� .�� 3� 57 � -c�izS
Power Supplier ' ress it ,
`. \ � '
X Cn� IS No��� �i �.
Elechical Contraclor (Company Nome) Conhaclor License No. Master Lic. No. �Plant Elect. Oniy�
C7W n e v�
Mailirg Address �Conhactor or Ownar Performing Insla. ion)
°�.YY�Q„
Aufhorized Signulure �Conkacbr or Owner I'erforming Installation) Phone No.
�-�'`"-e 763 •57 I - o( 2 $'
&OOOOIA-11 8/96 STATE BO RD COPY - SEE iNSTRUCTIONS ON BACK OF YELLOW COPY