P - 81334REQUEST FOR ELECTRICAL INSPECTION
�:� o- 5 3 8� B121 Unrvess ry Ave. r Rm. S- 28, ISt. Paul, MN 55104 f
Phone (612) 642-0800 ,
Home Duplex Apt. Bldq. Other: New Addn
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b��eques�. r remorks i�ace ond on the back of the while mpy
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Calculafe Inspection Fee - This Inspection Requesf will not be accepted wifhout fhe mrrect Fee:
O[her Fee # Service En[rance Size Fee # Circuits/Feeders Fee
Mobile Home Park Siall 0 to 200 Amps 0 io 100 Amps
Sheet Ltg./Troffic Sig. Above 200_Am s Above 100,Amps
TransFormedGenemror INSPECTOR'S USE ONLY TOTAL
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Investigolive Fee --� � L'. -'i� / /'- "
THIS INSTALLATION MAY BE ORDERED DISCONNECTEp IF NOT COMPLETED WRHIN 18 MONT .
OFFlCE USE ONLY This requast void 18 momhs hnm validafion dala prinled in ihis box.
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PLEASE PRINT OR TYPE
Raquesr (� Rough In insp«tion requiredd ❑ Yes o Impecrion Olher Than Rough�ln: eady Now � Will Call
��I � I�oa m�n coll Me -mspecbr when .eody� Dale Ready:
I, licensed coNractar ❑ owner hereby request inspection af 1Fie above electrical work at.
No. � Tawnship Nome w Na.
I Power
Phone No.
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Molll�g A rass �Cammaor or Owne� Perlormlrg Insmllanon� � ��
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�A� � � 8� STATE BOARO COPY - SEE INSTfiUCiIONS ON BACK OF YELLOW COPY