P - 83243REGIUEST FOR ELECTRICAL INSPECTION �
�+ � �� � � �+ � 1n821eUniversty Ave.,rRm. Se12$ �St. Paul, MN 55104 �
Phone (612) 642-0800 `�'
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Re air
Air Cond. Hfg. Equip. Water Hh. toad 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.
�.U�RZ �E�G�tCE�ENT F4�`LActE �- �4�
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 Pork Stall 0 ro 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTA �O
Sign/Outline Ltg. Xfmc fs��
Alarm/Remote Control
Swimming Pool
I here ceAi that t in the electrical installation described herein on the dates stated
Irrigation Boo RagMn _ �are
Speciallns - -
Find7
Investigative fee d - � �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
, OFFICE USE ONLY This request void 18 months 6om validation date printeditr-thit�ox. .
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PLEASE PRINT OR TYPE
Request Dote Rougl�in inspecfion required$ ❑ Yes No Inspection Other Than RougMn: Ready Now ❑ Will Call
��`�. —�� (You must call the inspeclor when ready) Dafe Ready: � 6.+��
I, �licensed contractor ❑ owner hereby request inspection of the above electrical work at:
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Occupant
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Power Supplier
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Elecirical Conkactor (Company Name)
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Mailing Address �Conhactor or Owner f
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Authorized SipnaNre �Conhacbr or Ow
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COPY - SEE
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Phone No.
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Conhacfor License No. . Master Lic. No.
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Phone No.
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ItONS ON BACK OF YELLOW COPY