P - 80930REQUEST FOR ELECTRICAL INSPECTION ��'
�� J���+ T� � 8121 Unive s ry qVear Ron Sle; zr$ igt. Paul, MN 55104 ��
Phone (612) 642-0800 •�%'�
Home Duolex Aot Bld9. Other New Addn
Air Cond. Hig. Equip. Wafer Htr. Load Mgmt O�her:
Dryer Range Elec. Heal Temp. Service
"X" above fhe work covered by this requesG Enter remorks in this space ond on the back oF /he white copy only.
1�ir�N�l
Colculate Inspedion Fee - 7his Inspeclion Request will no� be accephed without lhe mrrecl fee:
O[her Fee # Serv�ce Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Streel Lfg./Traffic Sig. Above 200_Am s Above 100—Amps
Transformer/Generafor INSPECTOR'S USE ONLY TOTAL �O Sp
Sian/Outline Lta. Xfmr. �1
tl�e dares smred
_r___..._r__._.. F,�a� , °1� 7 C5�
investigative Fee �- ~ �
THIS INSTAILATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 monll�s from valida�ion dore printed in ihis box.
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* 0 7 9 3 8 4 7 5 s J7o�9
PLEASE PRINT OR TYPE
Request Date Rough�in Inspection required? ❑ Yes Inspecfion O�her Thon kough In: ❑ Ready Now III Coll
�t ��'�9� �You m�st mll Me Inspecmr when ready� Daa Ready:
I, �licensed contmcfor 0 owner hereby request inspection of �he obove electriwl work at:
l06 Addreu (Shee�, 6on, o� Rovte NoJ Ciy Zip Code
Sec�ion No. I iownship Name or
Occupa�f Phone
G�r?�l�eo.✓
Power Supplier qddress
c:�.��
Elxhical Con4onor �Company Nome� Conrcacbr Licanse No.
Standard Electric Co. Inc. CA01715
Mallhg Address (Connact r or er Pedorminq Inslallono�)
2672 Map�� d Drive, M�plwood MN 55109
n��no��d sa�v�«w�.+o, o, ow�e, Pe,r�.mmem�nM�.i ._ _.-
651-484-8044