P - 80609^ rl RE�UEST POR ELECTRICAL INSPECTION z�,��
8"�_��� ` � 8121eUniversry Ave� Rm &128,'SL Paul, MN 55104
Phone I6}2) 642-D800 �.�: �
" Home Duplex Apt Bldg. O�her. CJ//QE New Addn
Commerciol Industrial Parm �y (` /� Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Olhec
Dryer Range Elec Heat Temp. Service
"X" above the work covered by thit request Enter remarks in this spoce ond on fhe back of fhe white copy onfy.
30 Ami SE,rc�iC� jN �'sifR�fC6 9� v.VDER �h'oU�✓.D %6 SrY�D
In/ ,�iaCK y/I�CD
Colculate Inspeciion Fee - This Inspection Request will not be accepfed wifboul rhe correc� fee: '
Other Fee # Service Enhance Size Fee # Circuifs/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Sfreet Ltg./7raHic Sig. Above 200—Amps Above 100_Amps
TransFormer/Generalor INSPECTOH'S USE ONLY TOTAL_ _
Alarm/Remore Control iG c% (J � �} � '
Swimming Pool i hereb ceni �ha� I ins ecre Ae elec+�icol �ns�allotion descdbed here�� on the daies sr � �
Irrigotion Boom Roughin D
Speciallnspection �
� G
Fi� Dak ^ p
Investigative Fee — L %
THIS INSTALLATION MAY BE ORDERED DISCON ED IF NOT COMPLETED WITHIN 18 MONTHS.
. —_ . _ . .. ._ _ _l e_.._. .._--. .. __ -� d
I'm� IIIIIIIIIIIII�I I�III ��III III� ���I�I OFFICE USE ONLY This reqa srwid 7 B monihs hom validafion dote primed In this box. �
II
N0 B 0 2 2 7 2 5* ,�,/J-(� ���3=.I
PLEqSE PRINT OR TYPE ��
Request Dme Roughin inspec�ion required? Yes ❑ No Ins lion Oiher ihon Rou h-In.
�Yau mu:r mll the inspec�w when reody� Daie Reod ; 9 -� Ready Now Will Call
Y
I, ❑ licensed contractor �' owner hereby request inspection oF �he obove electri<al work at:
lob Address �Strre�, Box, or Rouk No.l .,...
or ivo. I Ronge No. � Fire No.
Occupont
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lecmcol G nkocbr�Compony No
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dailrng Address �Comranor or Ow
w�hori:ed Signorure (Com,anor or
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STATE BOANO COPY - SEE INS7pUCT10N3 ON BACK OF YELLOW