P - 81033REGIUEST FOR ELECTRICAL INSPECTION
8.� �—�� O � 8121 University A ear Rm. S-128,'St. Paul, MN 55104 =
' Phone(612)642-0800
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Re ai
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter r marks in this space and on the back of the white copy only.
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Calculaie Inspection Fee - This lnspec�ion Requesl will not be accepied withouf the correct fee:
Other Fee # Serv' trance ize Fee # Circuits/Feeders Fee
Mobile Home Park Stall � 0 2 mp ,Q�U 0 to 100 Amps .�U
Street Ctg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR's uSE oN�v TOTAL �
Sign/Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
I hereb certi that I ins the elechical installation described herein on the dates stafed
Irrigation Boom RoogMn Dare
Special Inspectio
Final _.. __... . Da ft=.
Investigative Fee (/
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED W HIN 18 MONT S.
.. , OFFICE U8E ONLY This roquest void 18 months kom validation date printed in this box.
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P EASE PRINT OR TYPE
Requesf fe RougFfin inspecfion �equired? ❑ Yes o Inspecfion Other Than Rouglrin: �� No ill Call
tZ� �You must call If�e inspeclor when ready� Date Ready: � 6 \
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I, licensed contractor ❑ owner hereby request inspection of the above electrical work at: �� Z Q
Job� res (Sheet, Box, or RouFe No.) ��� City�� f) � Zip c� ��
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Secfion No. Township Name or No. Ranpe No. Fire No. Couqlx �_ _
Phone .
�, � 5 �-I l o
plier Address �5� � ��. �
� 3/i`� � `l� i
:onhaclor Company Name) Contractor License No. Master Lic. No. �P!
BLAINE HTG. A,C ELECT., WC. /� �/� /'��' �'„
'erform� g Installation) �� ti(� j f.� J Ph� �� ��
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BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY �