P - 81309� REpUEST FOR ELECTRICAL INSPECTION
7�J G� J� (� 812YeUniversry A e�,rRm. Se 2r8,ISt. Paul, MN 55104
Phone (612) 642-0800
Home Duplex Apf. Bldg. Otfier: New
� Commercial Induslriol Farm Remoc
Air Cond. Hig. Equip. Waler Htr. Load Mgml. Ofhec
D er Ronge Elec. Heai Temp. Service
"X" above �he work covered by �his requesG En/er �remarks in Ihis spoce ond on the back o� Ihe whife copy
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Calculofe Inspecfion Fee - This Inspection Requesf will not be accepfed withouf �he correct fee:
Other Fee R Service Entrance Size Fee # Circuits/Feed�
Mobile Home Park Siall 0 ro 200 Amps � 0 to 100 Amps
Street Ltg./Traffic Sig. A6ove 200—Am s Above 100_
Transformer/Generotor INSPECTOH'S USE ONLY �TC
Pool
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, Addn
Fee
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Invesfigotive Fee � � �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONT S.
OFFICE USE ONLY This reqoesf void 18 momhs kam validalion dale prinled in �hls 6ox.
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*0�3237��* a�iaX
PLEASE PR1NT OR TYPE
Requ le Rougbin inspecfion r{uired? ❑ Yes No Inspection O�er Than Rough�ln�. ❑ Neody Now � Will Coll
/ —� (Vou mos� wll �he Inspecror when ready� Dote Ready:
I, nsed confracfor ❑ owner here6y requesi inspeclion of }he above electricol work aY.
Job Add.exz �Srreet, Bc�, ar Rw�e No.) G � Z�p Code
s'8'�' 9 c,�Ni ��v t-� � 1�
Sen�on No. Tawnship Name r No. Ronge No. Fire No. oony
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PMne No
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STATE BOARD
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ON BACK OF VELLOW COPY