P - 83096�—� ' RE(�UEST FOR ELECTRICAL INSPECTION
6 v, �—��� � 8121eUniversty A earRo�f Esle��ici't. P�ul, MN 55104 �
� Phone (612) 642-0800 ' '�
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Re ai
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
X" abo e the work covered by this request. Enter remarks in this space and o the back of the white c only.
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Calculate Inspection Fee - This Inspection Requesi will not be ccepted withouf the correcf fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall j 0 to 200 Amps .Q 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Amps Above 100 A
Transformer/Generator INSPECTOP'S USE ONLY T
Sign/Outline Lfg. Xfmr. � �
Alarm/Remote Control
Swimming Pool
_ I herebvi ceAiH ihaf I insoecfed the elechicel installaKon described herein on the daMS sta�ed .
Speciallnspe�fon �' " �
Final
Investigative fee
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WI IN 18 MONTHS.
,,. . OFFICE USE ONLY This request void 18 months from validafiop date printed in this box.
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PLEASE PRINT OR TYPE
R � �°re — � Rou h-i� +ns tion r uired8 ❑ Yes
g pec eq ❑ No InspecKon OTher Than RougMn: ❑ Ready Now Will Call
(You musf call the inspecfor when ready) Date Ready:
I, licensed contractor ❑ owner hereby request inspection of the above electrical work at:
1� ddress (Sheet, Box, or oufe No.) ' � City � Zip Code
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Sectio� No. Township Name or No. Range No. Fire No. Coun4✓f �
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Conhacfor jCompoy/�1JpmeV l. � r Conhactor License
Address (Conhactor or
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Plwne No.
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No.
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1 8/96 STATE'BOARD COPY - SEE INSTRU ONS ON BACK OF YELLOW COPY