P - 80904(� RE�UEST FOR ELECTRICAL INSPECTION `���
'� o J-14 3 � 8121eUnive s ry Ave. r Rm. 3 128 igt. Paul, MN 55104 ��
Phone(612)642-0800 a�'
Home Duplex Apt. Bldo. Ofher: New Addn
� Calculafe
Slreef
�pecfion Fee - 7his Inspa
Othe� Fee
� Pool
Boom
Water Htr. Load Mgmt. Ofher.
Elec. Hea� Temp. Service
request. Enter remarks in fhis space and on
Requesf wil) not be accepled wi�houf the mrrect fee:
Service Entrance Size Fee # Circuits
0 to 200 Amps 0 to 100 A
INSPECTOP'S USE ONLV
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copy only.
Fee
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 78 MONTHS.
OFFICE USE ONLY This request wid 18 monthx Irom mlida�ion da�e printed in this 6ox.
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I, �licensed confmctor ❑ owner hereby request inspecfion of ihe above electricol work at
Jab Address (SVeeL Bax, or Rowe No.� Ciry Zip Code
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