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 � ���� /
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Setlion No. Tawnship Name ar No.
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Occuponr �
Power Sup ier � � �
Elecrcicol Conv or �Com �y Name� Q
C.
Mailmq nddress IConrcacror or Owner Perfar�
Phone No.
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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