P - 81347�I REQUEST FOR ELECTRICAL INSPECTION a`�sG,�,
��I11�II (II I I II I II III II I I II III Mg2leUnlvessay A earRmf 5-128cS1. Paul, MN 55104 ���-
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Home Duplex Apt. Bldg. Other: New Addn
Hig. Equip. Water Htr. ^ Load Mgmt. Other:
Range Elec. Heat emp. Service
work covered by this request Enter remarks in this space and ar the back of the white copy
=�AV:_:i'� _LIiiCH iNSTALLH;IGN
ulate Inspectio� Fee - This Inspection Fepuest will not be acceptetl without the cwrect fee:
Other Fee K Service Enlrance Size Fee +� Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200_Amps Above 100_Amps
Transformer/Generator INSPECTOR'S OSE ONLV TOTAL9
Sign/Outline Ltq_ Xfmr. /�� -'�
Alarm/Remote Control
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Investigative �ev " - L Z —
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLEiED WITHIN 18 MONTHS.
OFFICE USE ONLY This request vad 18 months hom valitlation tlata Grintetl in [his box.
392-093 �5 �
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PLEASE PRINT OR TYPE
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IVOU mus[ call the inspectar when reetly) oete Reatly: `� �,� ,._�L,
I, u licensetl contractor ❑ owner hereby request inspection of ihe above electrical work at:
Job Atldress (Street, Box. or Route No ) Ciry Zlp Gotle
V1���ti1 a�ll.�.—.��1��JIF'fl ��� i!P I'ISIf1i.i.11 .J�r�i.��.:
SecGon No. Townshlp Name rn No. Rznge Na Fire No. Gounry
E1 i� �%il (i
Occupant PFrorie No.
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PowEr Supplie� y Pdtl�ess
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ElecVical Contreotor IGompany Name� Contractor Goense No. Nbs�er �ic. Nn (Plant Eled.Onry)
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Malllrg Address (Contrac�or or Owner Performing Installation)
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Authorized Signa[ure IGontrac[or or Owncr Psriwming Installation) , Phone No.
E8-00001A-11 8/95 STATE BOAFlO COPY - SEE INSTRUCTIONS ON BACK OF VELLpW COPV