P - 79795� REGIUEST FOR ELECTRICAL INSPECTION
� 0�� - 3 7 6 � 1n821eUniversrty A ea,r R pf Ele 28,'St. Paul, MN 55104 -
Phone (612) 642-08Uu �� /1 _
,��v t.e
Home Duplex Apt. Bldg. Other: (� ` New Addn
Commercial Industriol Farm �� Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered 6y this request. Enfer remarks in this space and on the back of Ihe white copy only.
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # Service Entrance Siz Fee # Circuits/Feeders Fee
Mobile Home Park Stal! 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR•s use oN�v TOTAL ` Sb
Sign/Outline Ltg. Xfmr. � �
Alarm/Remote Confrol
Swimming Pool
I here certi that I ins the elechical installotion described herein on the dates smted
Irrigation Boom RougMn ��, Z �3'0�
Special inspection �
Final � �L�
Investigative Fee �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void months from validation dafe printed in this box.
I I��I I) I�I II III II II) II III II III II III II (II II (I I�
I I �I -t►�(o� C
* 0 8 0 2 3 7 6 4* � � ��,s�
PLEASE PRINT OR TYPE
Request Date Rou Irin ins tion r uired?
g pec eq ❑ Yes o Inspection Other Than Rough-In: ❑ Ready Now ill Call
��'j,� � v% Z �You musf call ifie inspedor when ready) Date Ready:
I, ❑ licensed contractor � owner hereby request inspection of the above electrical work at:
Job Address (Sheet, Box, or Route No.� Ciy Zip Code
� $ Sl� /+�o/�/�O� S ! Fi�i �LF� SS�3 �
$ecfion No. Township Name or No. � Range No. Fire No. Couny
��� ��
Occupant Phone No.
� �R� ��3�,� so z -- / s' p�
Power Supplier Address �
�l�cc--L .�vr�v.[ r, .,�o , � �v,
Electrical Conkacbr puny Name) Conhacror License No. Masfer Lic. No. (Planf Elecf. Onfy)
Mailing Address �Conhacror Owne� Performing Installafion�
�
Authorized SignaNre (C r or Owner Performing Installafion) Phone No.
s�� -�S 9%
EB-00001 A-11 8/96 S E BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY