P - 80847, REQUEST FQR ELECTRICAL INSPECTION `�'"g��,
v.3. v� O�� � 8'21 Unive s ry Ave. r Rm. Se128,'St. Paul, MN 55104
� ,
< Phone (612) 642-OSQO �'
ome Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Re air
Air Cond. Htg. Equip. Water Hh. Load MgmL C3iher:
Dryer Range Elec. Heat Temp. Service .�
"X" above the work covered by this reques[ Entei remarks in �his s� and on the back of the whi�e copy only.
Su1wR8AN � Zl l0'72 � �vRN--A %C
Calculofe Inspec�ion Fee - 7his Inspec�ion Requesf will no� be accepfed w'ithou� the mrred fee:
Other Fee # Service Entrance Size Fee # Circui[s
Mobile Home Park Stall 0 to 200 Amps 0 ro l OQ A
Street Lig./Tmffic Sig. Above 200_Amps Above 100
Trnncfnrmer/Genarafor INSPECTOF'S USE ONLY
Fee
��za . 50
Swimming Pool I �� hereM canifv Ihot I msoected the electncal IDnollanon desulbed herai� o� Ihe
� THIS INSTALLATION MAY 9� ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLV This requesi void 7 8 momhs hom wlidation date printed m ihis bo..
�f {Ili {{ f{II 111 II I flI�IMIIIInIN1�ll �.�ya �
� 0 8 L 0 0 7 3 *
PLEASE PRINT OR TYPE
Reqoes� Da�e goug6in inspection required? ❑ Yes Inspecnon Olher Than Rough�ln: �teody Now � Will Call
—3—�t9 nW m�� �d� �,e ;�_��. w�� ��, �� R�dy
I, �,licensed confroctor ❑ owner hereby request inspecfion of �he above electrical wark at
Jab Address (SVee�, Bo., or Rouh No.) Ciry Zip Cade
�f� 'T"f hoRN t ¢ �a�oL'EY
Sactlon No. Townshio Nome w Na. Ra�ye Nn Fre No. Counry _
Omoponl
Po�, N
iS
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Phone No.
STATE BOqpU COPV - SEE INSTPUC CK OF YELLOW COPY