P - 83130REGIUEST FOR ELECTRICAL INSPECTION
6��- 9 6 4� M821eUniversty A earRm. S-128,ISt. Paul, MN 55104
Phone(612)642-0800
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Home Duplex Apt. Bldg. Other: New
Commercial Industrial Farm Remoc
Air Cond4�s Htg. Equip. Water Htr. Load Mgmt. Othsr:
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 whi►e copy
5� b ��►�� � 5 7g�
Calculate Inspection Fee - This Inspection Request will not be accepted without fhe correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders
Mobile Home Park Stall 0 to 200 Amps ( 0 to 100 Amps
Street Ltg./Troffic Sig. Above 200 Am s Above 100 Amp:
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
Sign/Outline Ltg. Xfmr. �
Alarm/Remote Conhol
Swimming Pool
I hereb certi ' that I ins ted the electrical inslallafion described herein on the dates sP
Irrigation Boom Rough-In Da�e
S�ecial Insoectibi � �1 n
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Fee
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Investigative Fee - �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 1 MONTHS.
OFFICE USE ONLY This request void 18 months from validation date printed in this box.
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* 0 6 1 1 9 6 4 8* 1l°3S
PLEASE PRINT OR TYPE
R uesf Dafe +�`' Rough-in inspecfion required? ❑ Yes No Inspecfion Other Than Roughan:
�/ - 3 � (You must call the inspector when ready) Date Ready:
I, �icensed contractor ❑ owner hereby request inspection of the above elecfrical work at:
Job Address (SMeet, Box, or Route No.) Ci �
! �/ e S fook j��; v Q r,` �
Secfion No. Township Name or No. Range No. Fire No. unty �
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roWe,
lechical Conhacror �Compan Name�
H�i �• c•ison E�.ectric, Inc .
�Aailinp Address IConfracfor or Owner Performina Installationl
NoW ❑ w�u coii
Q ��
Phone No.
� v� ��✓�-�S S�1 �C' j�la L�
Conhacror License No. Master Lic. No. (Plant Elecf.
CA00808
25 Nevada v nue No th, 301, Golden Valley 55427
,uth r e ' natu o a or or e erform' s t� ��� � Phone No.
U � 544-3300
-0000 A- 8/96 TATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY