P - 80874REQUEST FOR ELECTRICAL WSPECTION " �"�
���0-546 � 8121UniveSsryAearRm.Se28,ISt.PauI,MN55104 ��
Phone (612) 642-0800 �+`
I I Range � � Elec. Heaf � � Temp. Service �
Yyork covered by this requesf. Enter remarks in this space ond on ffie back of ihe whife copy only.
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IColculo�e Inspecfion Fee - This Inspection Requesf will not be occepied withoul the correct fee:
_ Ofhe� Fee N Service Entrance Size Fee #T Circuits/Feeders Fee
to 200 Amps � �/ � 0 ro 101
�ove 200—Amps Above 7
INSPECTOq'S USE ONLY
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� Invesfigafive Fee � � ��/�.ttit-�--.----- I x' (�"7' /
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF�NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ON�Y This request wid 18 mon*s irom validafion dore prinfed in �his box.
Ili�llllllllllilll�lllll�i�llllll�l� � �/30.�
* 0 7 3 0 5 4 6 9 s `t"�`;a
PLEASE PRINT OR TVPE
9��� � Rough-in inspanion requiredd ❑ Yes Inspecfian Oiher Than Raugh�in: ❑ Reody NoJ�Jill Call
7 0 � ��
�You mast mll Me In.pecror whe� reody� Dore Ready:
( ' _ — —
Ilcensed conlractor 0 owner hereby request inspection of ihe obove electrical work at:
o Addrass �Sheet, Box, m Rovk No.) City Zip Code
l�y� �ie�r� �i��� f l��
cnon No. Tavnehip Nome a Na. Ronqe Nn Fre No. CounW �
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or (M�ner Yedorming In.
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ctar or Owree Pedrmia
Phone No.
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