P - 80204REQUEST FOR ELECTRICAL INSPECTION 4°��3;
8 O�° 2 91 � B121eUnivess Ty A ear Rm. S 2r8,ISt. Paul, MN 55104 ��
, Phone (612) 642-08f�9� �+�
Home
"X" above fhe
r�pr. oiag. �mer/' �N '-VN-//� � rvew
Farm , � yl� ` Remod
Wafer Htr. Lood Mgmt. Ofher. �^ �
Elec. Heot Temp. Service f0
requesG Enter remarks in /his spo<e and on the bock of the whi�e copy
Calculate lnspec/ion Fee - This Inspection Requesl wi�l noi be occepted wilhoul Ihe cor�ect fee:
pther Pee # Service Enhanw Size Fee S CirCUits(Feeders
Mobile Home Park Stoll 0 to 200 Amps 0 to 100 Amps
Sireef L�g./7mffic Sig. Above 200_Amps Above 100_Ar
Tmnsformer/Genemfor INSPECTOR'S USE ONLY TOT,
SignfOudine Ug. Rfmr.
Alorm/Remote Control � ��i��/°_
VJ
� Invesligofive Fee �
THIS INSTALLATION MAY BE
Fee
a?1 sa I
�-�—�— / ' b -�J
IF NOT COMPLETED WITHIN 18 MONTHS.
. ._..____ . _ —_
OFFICE USE ONLV In�s raqaes� wid � 6 momhs ficm volidm� date p��nted i� thiv bo..
IIN II III III I IIIII I I IIIIII IIII / '/
* D 8 0 2 2 9 L 5* PLEAS�a� oA n'P a/ ��
N que9 Da1e Rough in inspetlion requlred? ❑ �es No Inspedion Olher Than Rougbin: ❑ Ready Now WIII Coll
f/ _ 6_ Q �You mus� call the Inspeclor wM1en ready� Date Ready:
I, ❑ licensed contractor q/'owner hereby reques� inspection of the above elecfrical work at:
Zip Code �
Jab Address (Street, 6ox. or Ro k No I ��ry [�/ _ �+�i/ ?
13 !3 f��� %� `{ S 7r�
Power
Towrehip }Nome or Na. ^y� ;� °y � ' -" � " yi �
3� . l aJ!j�. ��N1J L[�
< . �41..Y
Phone Na.
'�Y �i�i �6 � -S7e- �?.
Add,e,�p�s ylvr� D�i�s�b�
�r�r'Campony Nomel Conrcaclor Licenu No. Nwster Lic. No. �PI
O W �'�t.°✓'
ass �Conimaor or Owner Pedorming Insmllotiw)
or/OwPe.Per(orm� Installanon) �`����/����
�'�/ O
STATE 60AR0 fAPY - SEE INSTRUCTIONS ON BACK OF �ELLOW COPV