P - 80694REQUEST FOR ELECTRICAL INSPECTION
7'"� ���� � 4' � � M821 Universry A earRm. Se128,ISt. Paul, MN 55104
Phone(612)642-0800
Home Duplex Apt. Bldg. Other: New
Commercial Industrial Farm Remod
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enier remarks in this space and on the back of the white copy c
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Calculate Inspection Fee - This Inspection Request will not be accepted wiihout the correct (ee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTA'!J�
Sign/Outline Ltg. Xfmr. �
Alarm/Remote Conhol
Swimming Pool
I hereb certi that I ins ted the elechical installafion described herein on the dates staAed
I��i9atiOn BOOro RougMn Date
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Fee
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THIS INSTALI.ATiON MAY BE ORDERED DI NECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 monfhs from validation date printed in this box.
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P EASE PRINT OR TYPE
Request Dafe /� M Rough-in inspecfion required? ❑ Yes No Inspecfion Other Than RougMn: ❑ Ready N Will Call
(S% °°y�� (You musf call ihe inspecFor when ready) Dafe Ready:
I, icensed contractor ❑ owner hereby request inspection of the above electrica) work at:
lob Ad r Sheet, Box, or ute No.) ty Zip Code
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Section No. Township Name or No. Range No. Fire No. uny .
Occupant
or
Authorized �nat�je �Cor�Bcfor or
Phone No.
AtltlfB
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Conf cfor Lic o. � Masfer Lic. No. (Plant Elect. C
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`orming Installation
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� Pe rming Ins fi� .� e N ���
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E BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY