P - 79621REQUEST FOR ELECTRICAL INSPECTION �'"'L`�,
� o�- 2 9 5 � M821eUniversary Ave. r Rm. SQ 2rB,15t. Paul, MN 55104 ��
Phone (612) 642-0800 ���
Home Duplex Apt.8ldg. Oiher: C New Addn
Cnmmwrrinl Industrial Farm �7LIS 1 1Q�i(��Rie� Remoti Reoai�
I�,X.
� Elec Heaf � � Temp. Service
iequesG Ente� remarks b fhis sF
/.�00
Calculafe lnspecfion Fee - This Inspedion Requesf wil) nof be occepted wi�houf the mrrect fee:
Other Fee # Servim Enirance Size Fee # Circuits
Mobile Home Park Stoll O to 200 Amps O to 100 A
Sfree� Ltg./Tmffic Si Above 200_Am s Above 100
Tmnsformer/Gener t SPECTOR'S USE ONLY
mote Canfrol
� Pool
Boom
copy
Fee
THIS INSTALLATION MAY BE ORDERED D1369NNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFflCH USE ONLY This reqoeslwid 1 B months hom wlidation dole primed In ihis 6ox.
I�IIIIIII{IIIIII IIII IIIIIIIIIININ NII ,��b9��//
PLEASE PRINT OR TVPE �/��
Req11uest Da�e Nougbin inspeciion required? ❑ Yes �'FJo Inspecfion O�her Than Raugh-In: ❑ Ready Naw Will Call
�� �.7 0� poa mus� mll �he I�specror when ready� Dore Ready:
I, �licensed <onlmcror ❑ owner hereby requesf inspection of the above electrical work at:
Job Address (Srceel, Box, or Roore No.� Gy Zip Code
I1a71 1<<tiS-f-�� G+ �i" F�,���ey S S43`�-
�4 Y l-�,var�
a��Pa�� !`'1 A v e e,� �.n I ( � ,�s � �� Phone7.63 -S -(a�d5`1
Power Suppller Address
�L ' C�s i�r�li N
Elecvical Ca� y�br (COmpan Name� vact« lke�x N. Nwster lic No. �Phm 0xt Ooly)
�.a��Clw� �1ec.����c 1,�C_ CA �39�
Molll�g Address �COO�mcror or 0..� r Pedorml�g I�smllo�iorQ
3511 - I S�N� l,au� N, �!,
Amhaiud - aWre I ��r o r Pe r ng Insmllo�ion� Phone No.
'j(e3-`f2.!-f(3�
EBOOOOIA-1 I B/96 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY