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P - 81794: REQUEST FOR ELECTRICAL INSPECTION � 8�� - 219 � 8f21eUniversty A ea,rRm. S 128,'St. Paul, MN 55104 � �t 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. /��'��� .�'� � � �,� _�°S- 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. I IIII �� I�I �� ��� li ��I �I ��I I� ��� I� �,� �a5� • �I ��Il� * 0 8 2 6 2 1 9 8* a�� ' d 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: �/ I ' ensed contractor ❑ owner hereby request inspection of the above elechical work at: Job Addreu (Sheet, Box, or Route No.� Ciy Zip Code t'S� ,o �z� L Secfion No. Township Name or No. � h Range o. ire No. Cou � r5�3 j9- p� � Phone No. � -<�13 �o„�N C��} I��,�.� - � EB-00001 A-11 STATE BOARD C - SEE INSTRUCTIONS ON BACK OF YELLOW COPY