P - 83539REQUEST FOR ELECTRICAL INSPECTION ��� .
7�:� = 8 5 4� 8121eUniversaty A earRm. S-128,ISt. Paul, MN 55104 a
- 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.
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Calculate Inspection Fee - This Inspection Requesi will not be accepted without ihe correct fee:
Other Fee # Service Entrance Size fee Circuits/Feeders
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./TrafFic Sig. Above 200 Am s Above 100 AR
Transformer/Generator INSPECTOR'S USE ONLY TOT�
Sign/Outline Ltg. Xfmr.
Alarm/Remote Conhol
Swimming Pool I herebvi certify that I
described herein on the da�es stated
Fee
C�i
Special Inspe�jo� ( � � , � `
�p^°E � o�
Investigative Fee
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requesf void 1 S monihs from validation date prinfed in fhis box.
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PLEASE PRINT OR TYPE
Request Date Rough-in inspeclion required? Yes ❑ No Inspection Other Than Rough-In: Ready Now ❑ Will Call
� Z�t � Y� (You musf cnll Ihe inspecfor when ready) Date Ready:
I, t�licensed contractor ❑ owner hereby request inspecfion of the above elecfrical work at:
Job Address (Strcet, Box, or Route No.) Zip Code
t�a3 G�ie.�.�-u �- A� ��. � �cd� t 5 2.._
$ection No. Township Name or No. Ranpe No. Fire No. ounry
� Occupant
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�Contracror or n�Pedo jng InsMllafion)
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STATE BOARD COPY - SEE
Phone No.
Master Lic. No.
Phone ! . �� �'j
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ON BACK OF YELLOW COPY