P - 83446REQUEST FOR ELECTRICAL INSPECTION
6" O�"�°' � 8121eUni essity A earRm. S-128,ISt. Paul, MN 55104 ��
Phone(612)642-0800
-Home Duplex Apt. Bidg. Other: New Addn
Commercial Industrial Farm - Remod e air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above �he work covered by this request. Ent remarks in this space and on the back of the white copy only.
R� 1 � �`-�/� ` �P ��-��c--
Calculate Inspection Fee - This Inspection Request will no► be accepied withou► the correct fee:
Other Fee # Service Entrance ize Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 00 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TO L.�
Sign/Outline Lig. Xfmr.
Alarm/Remote Control
$wimming Pool
I hereb certi that I ins ed the eleckical installafion described herein on the doles staled
Irrigafion Boom _ Ro�gMo p�
Special Inspe
Final
Imestigative Fee ��
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFlCE USE ONLY This request void 18 months from validation dafe printed in this box.
�I�O��I����I���I�il��l��ll�������1����I • �.�
* 0 6 8 0 9 6 9 3* �Q�,3
PLEASE PRINT OR TYPE
RequestL D/a�te� Q Rough-in inspection required? ❑ Yes No Inspecfion Ofher Than Rough-In: dy Now ❑ Will Call
/ d^ � � (You musf call fhe inspector when ready) Date Ready:
I, �-licensed contractor ❑ owner hereby request inspection of the above elecfrical work at:
1ob Address �Sfreef, Box, or Route No.� City � Zip Code
v� - Lo,� lv� .c�. --.���
Seclion No. Township Name or No Range No. Fire No. Co
Occup ' • phone No.
�r �hR L � � �83 - /��s-
Power $upplier Address
Elechical o actor (Company Name� � Conhacfor License No. Master lic. No. (Planf Elec1. Only)
l `=JG�c_.(/�/ �' / C/ � V
M g Address (Conhacfor or Owner P rmirg Installafion)
� � V � ��. ' � v �� �
�gnafure � acfor Owner Performing Installafion� �� t-� �� ` ' Phone No�. / /� �
V J ��Y —S
E OOIA-1 1 8/ 6 ST 80ARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY