P - 82793RE(�UEST FOR ELECTRICAL INSPECTION °'E
��-F ���) � O � iA821 Univers� A ea,rRm. 8 128,ISt. Paul, MN 55104 �
Phone (612) 642-OS00 `'�'
omP Duolex Aot. Blda. Other. New �n
' ercial Industrial Farm Remod . Re air
Air Co Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. E ter remarks in this space and the back of the white copy only.
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� C.�r: � t� 1 % � � �%
Calculate Inspection Fee - This Inspection Request will not be accepted without the correci 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 Sig. Above 200 Am s Above 1 UO Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTALf��
Sign/Oudine Ltg. Xfmr. �
Alarm/Remote Conhol
Swimming Pool I hereb certi that I ins fhe electrical installafion dexribed herein on the dotes stated
�rriqation Boor� Ro„��„ �re
Investigative Fee — �� 23 —
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITkjIN 18 MONTHS.
OFFICE USE ON�Y This request void 18 monfhs kom validation date printed in fhis box.
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* 0 6 4? 6 1 0 5* `�G�D/
PL SE PRINT OR TYPE
R uest D Rou h-in ins ion r u�red?
g pecl' eq ' ❑ Yes No Inspeclion Other Than RougMn: eady Now � Will Call
- �You musf call Ihe inspeclor when ready) Dafe Ready: �
I, licensed contractor ❑ owner hereby request inspection of the above elecfrical work at:
Job Q,�dress (Sheet, �or R� o.) �� Ci Zip Code
S'� �5 �
Section No. Township Name or No. �- ti e No. Fire No. Cou
v � � �
pa� � Phone No.
Power Supplier v
Eleylrical Conhactor
1
or CTNner Yertormino Insfallafionl . w/I -- �
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STATE BOARD COPY - SEE INSTRUCTIONS N��(SP�YELLOW COPY