P - 81331� RE�UEST FOR ELECTRICAL TION t��"�
7 Q� 2 5 4� Mg27QUniversry Ave. Rm. Se12r8,ISL Paul, MN 55104 � E,i•
! Phone (612) 642-0800 ���
Home Duplex � Apt. Bldg. Other: [71 New Addn
a7�
Air Cond. Htg. E uip. Water Htr. Load Mgmt. Olher:
Dryer Range Elec. Heat Temp. Service
"X" above �he work covered by lhis request. En/er remarks in this space and on fhe back of the white copy only.
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Loc,l� r3o� -t,�,C,�. �2 �1.E.S.
Calculote fnspeclion Fee - This Mspeclion Requesi will not be accepted wifhau� fhe mrrecf fee:
Other Fee # Service Enhance Size Fee 7i Circuils/Feeders Fee
Mobile Home Pqrk Stall 0 to 200 Amps 0 to 100 Amps
Strcei Ltg./Traffic Sig. Above 200_Amps Above 100_Amps
Transformer/Genero�or INSPECTOR'S USE ONLY TOTAL ,,....a
Alarm/Remote Control 'Yt Sv
oR�-
Swimming Pool I hereb cem �ha� I���s red ihe electdcol innallai�o� described here�� o� ihe dams :rored
���i9pfiOn Boprti Rwghln � Da�e
Special Inspecti - ( . � 2q'� ��
Investigofive Fee � ��e ^ /' ��
7HIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTNS.
OFFICE USE ONLY This reqoezlvoid I B months hom wlidotion da�e printed in ihis 6ox.
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* 0 7❑ 4 2 5 4 2* 3/ j 7
PLEASE PRINT OR TYPE
Requesr Dale Roughin inspec9on requtred? ❑ Yes � No Inspection Other ihon RoughJn: ❑ Ready Now WIII Call
� �You musrcoll�he inspec�orwhen reody) Dale Ready:
I, VJ licensed confracror ❑ owner hereby request inspecfion of Ihe obove elettriml work at:
lab Addrass (Street, Box, or Routa NoJ Ciry ` , yp Code
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Sec�ion No. Township Name or No. Ranqe No. Fire No. CoonN
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STATE BOMD COPY - E iSTNUCT10N5 ON
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Phorie No.