P - 81794: REQUEST FOR ELECTRICAL INSPECTION �
8�� - 219 � 8f21eUniversty A ea,rRm. S 128,'St. Paul, MN 55104 �
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Phone(612)642-0800 "�'
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod e oir
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this r Enter remarks in this space and on the back of the white copy only.
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Calcu ate Inspection Fee - This Inspection Request will not be accepted withou► ihe correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
obile Home Park 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 ON�Y TOT �y G,�
Sign/Oudine Lfg. Xfmr. (/'� J `�
Alarm/Remote Conhol �Q �
Swimming Pool
I hereb certi thot I ins the eleclrical installation described herein on the dates stated
Irrigation Bo RougMn Dafe
Special Inspec o
Final Dare
Investigotive Fee �y- C-,�-
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This roquest wid 16 months from validation date printed in this box.
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PLEASE PRINT OR TYPE
Request D Rough-in inspection required? ❑ Yes o Inspecfion Other Than Rough-In: ❑ Ready No Will Call
�li� O (You must call the inspecfor when rea Date Ready:
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I ' ensed contractor ❑ owner hereby request inspection of the above elechical work at:
Job Addreu (Sheet, Box, or Route No.� Ciy Zip Code
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Secfion No. Township Name or No. � h Range o. ire No. Cou �
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p� � Phone No.
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EB-00001 A-11 STATE BOARD C - SEE INSTRUCTIONS ON BACK OF YELLOW COPY