P - 80747FiEQUEST FOR ELECTRICAL INSPECTION `
8 2 2�� 5 6� 8121eUniversty A ea,rRm. S 128,ISt. Paul, MN 55104 �
, Phone (612) 642-0800 " '
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Re air
Airf'�.' Htg. Equip. Woter Htr. Load Mgmt. Other.
Dryer ange Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on the back of ►he white copy only.
P.�MS � -z z.45� , ���n ---,� I c
Calculate Inspection Fee - This Inspection Request will not be accepted withoui the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders
Mobile Home Park Stall 0 to 200 Amps z, 0 to 100 Amps
$treet Ltg./Traffic Sig. Above 200 Am s Above 100 Ar
Transformer/Generator INSPEC70R'S USE ONLY TOT�
line Ltg. Xfmr.
mote Controf
� Pool ,
I here certi that I
Boomo......� �..
Da1e
�
Fee
00
Investigative Fee F��� C I�2 �y 7---�� 7
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requesf void 18 months (rom validafion date printed in fhis box.
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PLEASE PRINT OR TYPE
Requesf Date Rough-in inspecfion required$ ❑ Yes o InspecFion Other Than RougMn: �Qeady Now ❑ Will Call
�� z 9� �You musf call the inspeclor when ready� Date Ready: . I�+
I,�icensed contractor ❑ owner hereby request inspection of the above elechical work at:
Job Address (Sfreet, Box, or Roufe No.) City Zip Code
i 301 -�R. 3Z
Secfion No. Township Name or No. Range No. Fire No. County
Occupanf
0
rowe�
Phone No.
�o iz� '7i�{ -
Elechical Conhacfor �Company Name) Conkacfor License No. Master Lic. No. �Planf Eled.
`NC � ��T�-(c.�C� �AOo80P�
Mailing Address (Con}racfor or Owner Performing Insfallafion) � �
5 30l �y�� S•siZ�
Z ZS i�iLt.b�o�Q�t�EVt,w2_t�lG•� � C—�c�lc���f
Aufhorized Signoture (Contmctor or Owner Performiny�a�ie.�aM}�--,� Phone No.
STATE BOARD COPY -�1 —CTIONS ON BACK OF YELLOW COPY