P - 80894�lOq RE�UEST FOR ELECTRICAL INSPECTION '��°��
8,131 O O 1 � 8121eUni ess ry A eef Rm. Se 2r8,ISt. Paul, MN 55104
Phone (612) 642-0800 ��
Home Duplex AQt. Bldg. Other: New Addn
Commerciol Industrial Farm ��i1J v'������"� Remod Re air
Air Cond. Hig. Equip. Wafer Hfr. Load Mgmt Ofher
Dryer Range Elec. Heaf Temp. Service
°X" above fhe work covered by fhis requesG Enfer remarks in this space ond on the back oF the white copy enly.
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Calcula�e Inspection Fee - This Inspecfion Request will not be accepfed wi�hout �he correc� fee:
Other Fee # Service Entrance Size Fee # Circuits
Mobile Home Park Stoll 0 fo 200 Amps 0 �0 100 A
Sfreef Lfq./Tmffic Siq. Above 200_Amps Above 100
TrnncFn.mer/Qenernfnr INSPECTOR'SUSEONLY
on �he dmes
Fee
�
0
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
I�filllllfllllllllll IIIIIII�IIIIIIIIIII�� OFFICEUSEONLY Thia requestvoid 18 monihs�voldotiondale�; �s6ox
* 0 8 0 1 0 8 1 1* �Q/
PLEASE PRINT OR TYPE
_ � Rough-in inspedion required? : Inspenian O�her Than Rough-In: �Ready Now � Will Coll
�VOU mos� call the Inspenor when ready� Dare Ready.
sed contmcfor ❑ owner hereby requesf inspection of fhe above elechical work at:
ineel, Boz, or Rwle No.� Ciy Zip Code
7 QNpN � PiG-y} S� �FYZL�O►„
Township Name or No. � Range Na Flre Nn Counry
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,���.�o, a, �,�� Pe,�,m;�9 ��,�e��o„o�,
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Phone No.
t,�L- 78i - 3�i
Maskr Lic. No.
3b�
s-s� � �
No.
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STATE BOARD COPY - SEE INSTpUCTIONS ON BACK OF VELLOW COPY