P - 84334RE(IUEST FOR ELECTRICAL INSPECTION -�..
���� ��� � in821 Univers ty A ea,r Rm. S-128,'St. Paul, MN 55104
� Phone (612) 642-0800 ��/��
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Commercial Industrial Farm Kemoa � Ke u
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remar m this space and on the back of the white copy only.
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Calculaie Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # Service Entrance Size Fee '# Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps ,�QG
Street Ltg./Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator WSPECTOR'S USE ONLY TOTAI /�
5ign/Outline Ltg. Xfmr. � �f
Alarm/Remote Control � z� J� r-��
Swimming Pool
I hereb certi that I ins ted ihe electrical installation described herein on fhe dates sfated
Irrigation Boom Rough-In � �"7
Special Inspection ���— e �
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Imestigative Fee •— � _ ..•- .� t`� — '- � �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED THIN 18 MONTHS.
f � OFFICE USE ONLY This requesf void 1 8 months from validation [iate prinfed in fhis box.
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PLEASE PRINT OR TYPE
Request Date Rou h-in ins ecfion re uired? Yes
g p q ❑ No Inspection Other Than Rough-In: ❑ Ready No Will Call
�/�% �� `�- -� �You must mll the inspector en ready) Date Ready:
I, �icensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (STreet, Bo�yef Route No.� � City �r.� �` Zip Code
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Secfion No. To ip Name or No. Range No. Fire No.
Power $upplier
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or ner PerForming Insfallation
ictqr or OWner Pe on ' ig Insta la�
Phone No.
Controctor License No. Master Lic. No.
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1 1 8/96 TATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY