P - 81031r REQUEST FOR ELECTRICAL INSPECTION `�
g 4 0- 2 3 4� 8121 Uni eSsity A earRm. S-128,ISt. Paul, MN 55104
' Phone (612) 642-0800 "�'
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industriai Farm Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer 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.
��� c� �.�-Y,
�����. �s,--,��-��� s
Calculate Inspection Fee - This Inspecfion Request will not be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECroR'S USE ON�v TOTAL L
Sign/Outline Ltg. Xfmr. � ' J�
A(arm/Remote Control
Swimming Pool
I hereb certi thaf I ins the elechical installation described herein on the dates stafed
Irri9ation Boom RougMn Date
Special Inspection
Fiiwl
Investigative Fee �-.% •-
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WI 1 i8 MONTN .
. OFFlCE USE ONLY This requesf void 1 B monfhs from validafion date printed in fhis box.
�I�N�II�IIIII�I��III��I�III�I������I� �► �-�
* 0 8 4 0 2 3 4 9� 6�� -�
PLEASE PRINT OR TYPE
Request Dale Rou h-in ins �on r uired?
g pect' eq ❑ Yes No Inspection Other Than Rough-In: ❑ Ready Now Will Call
O.� �— (You must coll the inspecfor when ready) � Date Ready:
i, (�licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Addreu �Street, Box, or Route No.) City Zip CaJe
� s�b ..�c 5�-�. j- iGQ.� 55�3�-
Section No. Township Name or No. Range No. Fire No. County
Occupan� , ^ � Phone No.
ar.ri. � � a-g�5$
cxs.r.�t,
Power Supplier Address
� Mailing Address
Confrador license No. Master Lic. No. (Plant Elecf.
ELECT., i�l., � �%��%�in
A�G� N r
n actoTo rmer Performi� Installation�` � i iV ,�, I Pho� ����O
S7,pTE 60ARD;SOPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY