P - 80937t�(y REQUEST FOR ELECTRICAL INSPECTION ��� �
8L1J-301 � 821eUnlversa� BoarRm.S�12�8,�St.PauI,MN55104 _��
.. Phone (612) 642-0800 --�
Air Cand. Ht . Equip. Wafer Hh. Lood Mgmt. Othec
Dryer Range E1ec. Heat Temp. Senice
"X" a ove the work covered by this requesL Enfe� remarlks in Ihis spore and on the back of the whife copy only.
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Calwlate Inspection Fee - This Inspec�ion Request will nol be accep�ed wifhau/ Ihe correcl fee:
Other Fee # Service Enirance Size Fee # Circui[s/Feeders Fee
Mobile Home Park Sfall 0 fo 200 Amps 0 ta 100 Amps
Street ltg./TmBic Si . Above 200_Am s Above 100_Amps
Transformer/Genemfor INSPECTOWS USE ONLV TOT
Sign/Oulline L1g. Xfmr.
Alarm/Remote CoMrol �U S�
Swimming Pool , �._,e�., �e,,;F, ��.,,, �,,,.,e.�on ��,o aia��.��,.i ,,,a�ii�r.,,, da,�db d he,e�� o� ihe daaz srmed
Imesfigolive Fee �� � �� —� �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requesf vold I B momhs hom wlidation dale p6med In this box.
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* 0 8 2 0 3 0 1 0 s �o��
PLEASE PRINT OR TYPE
R Rough in inspecfion requiredz ❑ yes No In:penion Oihx Thon Rough-In: ❑ Ready Now Will Call
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�� � (Yoo mo:� mll rhe inspecbr when readyl Dare Ready:
I, licensed confmcto� ❑ owner hereby request inspection of ihe above electriml work at
lab Addresz (Sree6 Bo., o� Roure NoJ � Cirv r., r..de
or rvo. � Range No.
Plwne
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BOARD COPY - SEE WSTRUCTIONS ON BACK OF YELLOW COPY