P - 82944�
� REGIUEST FOR ELECTRICAL INSPECTION
����� O� � 8'21 University A ea,r Rm. S-128,'St. Paul, MN 55104
Phone (612) 642-0800
Home Duplex Apt. Bldg. Other. New Addn
Co mercial Industrial Farm Remod e air
ir Co tg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
„X" above the wo k covered by this request. Enter remarks in this space and on the back of the white copy only.
�v��rbo� 1�-77� �
Calculate Inspection 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 , �O
Street Ltg./TrafFic Sig. Above 200 Am s A6ove l OQ Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL �
Sign/Outline Ltg. Xfmr. �r�' S^r%
Alarm/Remote Conhol
Swimming Pool
I hereb ceAi thot I ins the elechical installation described herein on the dates sMfed
Irrigation Boom RoogMo Dare
Special Inspectio
Final
Investigative Fee � " "`� �
THIS INSTALLATION MAY BE ORDERED DISCON ECTEQ IF NOT COMPLETED WITHIN 18 MONTHS.
��I I) III II III II III II I OFFICE USE ONLY This requesf wid 18 monfhs irom validation date prinfed in ihis box.
Ili�i��l�i�i�����ll���l • ,�: �
* 0 6 4 7 5 0 5 7* �� 70�
PL E PRINT OR TYPE
Requesf Date �� Rou h-in ins on r uired? ❑ Yes No Ins
� 9 P��� eq pecKon 01her Than RougMn: eady Now � Will Call
`� �You musf rnll fhe inspecfor when ready) Date Ready:
I, �censed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Addreu (Sheet, Box, w ute No Ci Zip Code
~ t �i eC'�i L' � �rC �. r:� �
Section No. Township Name or No. Range No. Fire No. Co fy �� �
ti
�
cooeocro.
Mailing Addres�onhacfor or Owner Performing
Phone No.
S' �l - 5'
Confracfor License No. � Master Lic.
or er P m stallation Phone No.
l
� �. b .�
STATE B ARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY