P - 83923�REQUEST FOR ELECTRICAL INSPECTION �::.. ,
�Ilfll (�I�I IIIII IIIII IIIII IIIII IIIII IIIII IIII (III 1^g2leUni eSs ty A earRmf S1e BcSt. Paul, MN 55104 �: ��;
* 0 3 6 0 0 4 6 7* Phone (612) 642-0800 ������
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat emp. Service
"X" above the work covered by ihis request. Enter remarks in this space and on the back of the white copy only.
I
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Calculate Inspection Fee - This Inspection Request will not be accepted without the conect tee:
Other Fee # Service Entrance Size Fee � Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLV TOTAL ��
Sign/Outline Ltg. Xfmr. �
Alarm/Remote Control
Swimming Pool I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In Date _
Speciallnspe ,
" ' .�„ , - Final D te - /�
Investigative Fee � =�� �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
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OFFICE USE ONLY This request void 18 months from validation date printed in this box.
360-046 [� � a ,� o �
,s-� � 7
PLEASE PRINT OR TYPE `� -�D
Request Date Rough-in inspection required? es ❑ No Inspection Other Than Rough-In: ❑ Ready Now ❑ Will Call
� �l� (You must call the inspector when ready) Date Ready:
I, [�licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
q5 �5 . f���f
Section No. Townshi me or No. Range No. Fire No. C unty
Occupant Phone No.
Wuct'c VS �S`�- /0 7
Power Supplier ^ Address
�— �J 1
Electrical Contractor (Company Name) Contractor License No. Master Lia No. (Plant Elect. Only)
� ' e� �� -�,.�r c` ia
Mailing Address (Contractor or Owner Perf rming Installation)
<333 ! � � L..a. �vw� � ,v�cr .�.
Authorized Signatur ontractor or Owner Performing Inst n) Phone No.
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11 8/95 � STATE BOARD ZOPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY