P - 82953RE(IUEST FOR ELECTRICAL INSPECTION
6���- 0 6 5� 1A821eU iversty A ear Rm. Se128,ISt. Paul, MN 55104
r Phone (612) 642-0800 `'°�'
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Re ir
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 on ihe back of the white copy only.
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Calculate Inspeciion Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Si . Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOT L 5O
SignjOutline Ltg. Xfmr. ""'�
Alarm/Remote Conhol
Swimming Pool
I here certi that I ins fed �e elecfrical installation described herein on the dates sta�ed
Irrigation m RougMn �a�
Speciol Ins
Final
Investigative Fee
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WIT IN 1 MONTHS.
OFFICE USE ONLY This requesf void 18 months from validation dafe printed in iifis box.
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PLEASE PRINT OR TYPE
Reques Dare Rough-in inspecfion required$ ❑ Yes ' No Inspection Ofher Than Rough-In: ❑ Ready Now Will Call
(You must call the inspeclor when ready� Date Ready:
I, licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sheet, Box, or Roule No.� City Zip Code
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Secfion No. Township Name or No. Range No. Fire No. ou
Occu nt Phone No.
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Power Supplier Address
Elechiwl �,�p�pyyy y�tq����CT., �NC•. Conhactor License No. Master Lic. No. �PlanT Elecl: Only)
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A1fE. N.E.
Mailing Address ( Installafion)
Aufhorized Si n re �Con cfor o ner Performi� Installafion! {^� Phone No. '
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EB 00001 A-11 /96 STATE BOAHD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY