P - 83346RE(�UEST FOR ELECTRICAL INSPECTION
�,�r )�� � J O � 1n821eUniversaty A ear Rm. Se128,'St. Paul, MN 55104 3
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Phone (612) 642-0800 `'�'
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial 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 reqvest. Enter remarks in ihis space and on the back of the white copy only.
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Calculaie Inspection fee - This Inspection Request will noi be accepied wifhout the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Pork Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL �
Sign/Outline Ltg. Xfmr. '�
Alarm/Remote Conhol
Swimming Pool
I hereb certi Ihaf t ins the electr'ica! installation described herein on fhe dates stated
Irrigation Boom ,� �,� _ RouaMn Da�e
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Investi ative Fee
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFlCE USE ONLY This request void 18 monfhs from validafion date prinfed in this box.
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LEASE PRINT OR TYPE
Request Date Rough-in inspecfion required8 ❑ Yes o Inspecfion Ofher Than RougMn: ❑ Ready Now ill Call
D� � (You must call the inspecfor when ready) Date Ready:
I, licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sneet, Box, or Roufe No.) Ciy Zip Code
Occupant
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?� dY�r u-� S� I�-Q . r i SS�f vZ
iship Name or o. Ranqe No. Fire No. CounN �
I Conkacfor (Company Name
Bun� Nrc�. �;� �ecr., u�C-
Phone No.
5��f -bo�f �
License No. Masfer Lic. No. (Pbnt Elecl.
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ON BACK OF YELLOW COPY