P - 84346� T REQUEST FOR ELECTRICAL INSPECTION �����:...
4��_"�� � 8'21 Univers Ty A ea,r Rm. S-128, ISt. Paul, MN 55104 �
Phone(612)642-0800 '�'
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm 'Remod Re air
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 the back of the white copy only.
Calculaie Inspection Fee - This Insp�
Other Fee
Mobile Home Park Stal)
Street Ltg./Traffic Sig.
Tra nsformer/Generator
Sign/Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
�n Request will not be accepted without the correct fee:
# Service Entrance Size Fee # Circuits/Feeders
0 to 200 Amps 0 to 100 Amps
Above 200 Amps Above 100 Am
INSPECTOR'S USE ONLY / {r TOTA
G�l, ! �G' Lc..�h �- �.�lj �L E �� z�ti,t, C.S��/ ,
Fee
�
I hereb certi that I ins cted the electrical installation deuribed herein on the dates stated
Irrigation Boom `, Rough-In �� � D�te �j
Speciallnspection < 7
Final ' --" Date
Imestigative Fee � � . — Z- ? —C
THIS INSTALLATIOIV MAY BE ORDERED DISCONN TED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requesf void 18 months from validafion date prinfed in fhis box.
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I IIII II III II III II III II III II III II Ii lli l llll �
* � 4 4��i ]� 4 9�K PLEASE PRINT OR TYPE
Request Dafe Rou h-in ins tion re uired? Xes
g pec q � ❑ No Inspection Other Than Rough-In: ❑ Ready Now Will Call
�, r� � �� (You must call the inspector wh n ready) Date Ready:
I, I'censed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Ro�.No.) ^ ^ City Z"�p Code
Name or No.
Occupanf��
�
Power Supplier
�—..
Electrical Cjonty�r �Company �
� I Authorized
1 A-11
Range No.
2
or Owner Performin ation
v�
cror or Ow r PerForming InstalL
L�
STATE BOARD COPY
Phone No.
x License No.
t�rl ! a
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Master Lic. No.
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Phone No.