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P - 81307RE�UEST FOR cLECTRICAL INSPECTION � 7 tSJa+� v U � 8121eUniv rstaty Avea,rqm. SI 128,'SL Paul. MN 55104 � � . Phone (672) 642-0800 -. Home Duplez Apt. Bldg. Other. New Commercial Indusfrial Farm Remod Air Cond. Hfg. Equip. Woter Htr. load Mgmt. Ofher. Dryer Range Elec. Heat Temp. Service "X" above �he work covered by this reques[ Enter remarks in this spoce and on the back of fhe whife copy (�r,t.r�v 6 0 /Q� „c.c�wu..� /m�. /40 � Calculafe Inspecfion Fee - 7his InspE Other Fee Mobile Home Park Stall Sireet Lfp./Tmffic Siq. 3 Pool Boom =quest will nol be Service Entrance INSPECTOR'S USE ONLV WN- f4�-y7 � herabvi certl�v �ol I wifhoul fhe correcf fee: Fee # Circui[s 0 fo 100 A ihe electriml insmllaiion dascdbed herei� o� �he dmes stated Fee THIS INSTALLATION MAY BE ORDERED DISCONNECTEU IF NOT COMPLETED WITHIN 18 MONTHS. � OFFICE USE ONLV Thls requesl void 16 monihs 6om wlida�ion dale prinled in ihis 6ox. I�I I II I I� I I I I II II I I I I�I I� I I� * 0 7 4 0 5 6 6 5* °�� � PLEASE PRINT OR TVPE Re9����0� Roogh in inspeciion required? ❑ Yes No Inspec�ion O�her TMn Rough-In: ❑ Ready Now Will Coll �� 3Q 9 9 (You most call �he Inspedor when ready� Dore Reody: I, �icensed controctor ❑ owner hereby request inspeclion of ihe above elecirical work al: Job Address�� ox, ar Ro�re No.� , �� Ciy � ���� / � C y�� n��9 Setlion No. Tawnship Name ar No. �o Occuponr � Power Sup ier � � � Elecrcicol Conv or �Com �y Name� Q C. Mailmq nddress IConrcacror or Owner Perfar� Phone No. � �� � 3//�h� �i�t.� G�J` �,.ci Connacror Lice�se No. Mas.er l�c No. �Plom E{en. o� caoo�s3 ,trnozs6 aornorizec >i mre I�onrvoaor or Vnner rerrormmg msiauov i / rnore rvo. �� %i1� Y7S� 36 3 `1 EB90001 A-I I 8/96 STATE B011ND COPV - SEE INSTHUCTIONS ON BACK OF YELLOW COPY