P - 83979REQUEST FOR ELECTRICAL INSPECTION
4 J�-131 � 1^821 University A earR nf ESe12$ ISt. Paul, MN 55104
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Phone(612)642-0800
Home Duplex Apt. Bldg. Other: New A dn
Commercial Industrial Farm ��- Remod e 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.
Calculate Inspection Fee - This Inspection Request will not be accep►ed withouf the correct fee:
Other Fee # Service Entrance ' e Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 00 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
Sign/Outline Ltg. Xfmr. ��� ��
Alarm/Remote Control
Swimming Pool
I hereb certi that 1 ins ted the electricaJ. installation described herein on fhe dafes stated
Irrigation Boom Ro„yM„ ,'� pa
Special Inspecti n � -- � � ' ��
Final �� Da1e� " �+�
Investigative F Yt--�--- �� �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 monlhs from validafion dafe prinfed in fhis box.
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* � 4 9 1 1 3 1 9�k PLEASE PRINT OR TYPE
Request Dofe Rou h-in ins fion r uired?
g pec eq ❑ Yes No Inspecfion Ot er Than Rough-In:
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I, licensed contractor ❑ owner hereby request inspection of the above electricol work at:
Job Address (Street, Box, or Route No.) ity
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Section No. Township Name or No. Range �. Fire No. County
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Ready Now ❑ Will Call
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