P - 82728REQUEST FOR ELECTRICAL INSPECTION �'�
5 J rJ — 0 21 � 1n821eUniversity A ea,r Rm. Se128,'St. Paul, MN 55104 �'�
r Phone (612) 642-0800 'm�'
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Re air
Air tg. Equip. Water Htr. L�ad Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by thi� t. EJ� mark_s in this space and on the back of the white copy only.
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Calculate Inspec►ion Fee - This Inspection Request will noi be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders F
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTA� y
Sign/Outline Ltg. Xfmr. S
Alarm/Remote Conhol
Swimming Pool
I hereb certi that I ins the electrical inslallation described herein on the dates stated
Irrigation Boom Rough-In Date
Speciallnsp r
Final D
investigative ee � �' 2 $
THIS INSTALLATION MAY BE ORDERED DISC CTFf1 IF NAT [`1)UDI FTGLLW�T����_ ►a •��-��• •^
� � � ppF10E USE ONLY This requesf void 1 S months from validafion date printed in ihis box.
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III�I II��I I��II (II II III IIIII II III It�I� ��3
* 0 5 9 6 � 2 1 6* PLEASE PRINT OR TYPE
Requesf Da i� •� �/ Rough-in inspecfion required� ❑ Yes ❑ No Inspecfion Other Than RougMn: eady Now 0 W�II Call
� (You must call the inspeclor when ready) Date Ready:
I, icensed contractor ❑ owner hereby request inspection of the above electricol work at:
: Job Address (SMeet, Box, or R te .� - . City Zip Code
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$ection No. Township Name w No. Range No. Fire No. Cou n � -
Occupant
Powe`r S `
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r Compan Name)
3i.E E�EeTRic, r�uc.
.o�� � 5roi
ts. MN b5433
�r ocror or Owner Perforrying/
License
Phone No.
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COPY - SEE INSTRIICTiONS ON BACK OF
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