P - 83907REQUEST FOR ELECTRICAL INSPECTION �
4 J�- 8 91 � 8121 University A earRm. S-128,'St. Paul, MN 55104
Phone 612 642-0800 �;
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Home Duplex Apt. Bldg. Other: New Addn
Com "al I strial Farm Remod Re air
ir Htg. Equip. Water Htr. Load Mgmt. Other:
Dry Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on the back of the white copy only. I
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders
Mobile Home Park Stall 0 to 200 Amps to 00 Amps
Street Ltg./Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOT
Sign/Outline Ltg. Xfmr.
Alarm/Remote Confrol
Swimming Pool
I hereb certi that I ins ted the electrical installafion described herein on the dates stated
Irriqation Boom u,.,,..i,,.. „_�
Investigative Fe �� �` ��' °��„--��' I ��%z 7 —G %
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFlCE USE ONLY This requesivoid 18 monfhs (rom validafion dafe printed in fhis box.
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* � 4 9 2 8 9 1 7* PLEASE PRINT OR TYPE �`� ��
Request Dafe,�� Rou h-in ins fion r uired? pec g �dy Now � Will Call
/ g pec eq ❑ Yes o Ins fion Olher Than Rou Mn:
(You must call fhe inspector when ready) Date Ready:
I, icensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street,�x, o�e .� C Zip Code
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Section No. Township Name or No. Ranqe No. Fire No. Counw
or
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License No. Masfer ic. No. (Plan�
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or er rerrormmg instau9hon) • � Phone No.
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STA�E BOARD COPY - SEE INSTRU�TIONS ON BACK OF YELLOW COPYT�
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