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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. � � 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. ��u�0��1������������1������l��i�������� • ff�/ p� * 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 -- � �� ^ � ^ � I 1 STATE BOARD COPY - SEE INSTRUCTIONS N��(SP�YELLOW COPY