P - 80658REQUEST FOR ELECTRICAL INSPECTION °'E
�'� � m� o� � 8121 Uni eSs� A earRm. S1 28,ISt. Paul, MN 55104 �
' Phone (612) 642-0800 "�°'
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Re air
Air Cond. Htg. Equip. WaTer Htr. toad Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" nbove the work covered by this request. Enter remarks in this space and on the back of the white copy only.
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Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mo6ile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR�s use oN�v . TOTA �
Sign/Outline Ltg. Xfmr. G� ,�,��
Alarm/Remote Conhol � N �
Swimming Pool
I hereb ceAi that I ins ted the etechical installMion described herein on the dotes smted
Irrigation Boom Rough-In Dare
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Invesrigative ree�j � 1f '�� '—�'--�
TtIIS INSTALLATION MAY BE ORDERED D{SCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFlCE USE ONLY This request void 18 mo�ths from validation date printed in this box.
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PLEASE PRINT OR TYPE
Reque Da ��� Rough-in inspection required$ ❑ Yes Inspeclion Other Than RougMn: eady Now [,� Will Call
�You must call the inspector when ready) Date Ready:
I, icensed confractor ❑ owner hereby request inspection of the above electrical work at:
Job dress (Sheer, Box, or Route No.� �� Ci4y � Zip Code
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SecTion No. Township Name or No. Range No. Fire No. County �
Occupan � D� ��! �� / � Phone Nq� �-7// ���
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I Power Supplier� `� � � �
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�ddress (Conkacbr or Owne Performing Inst Iafion)
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Fd Si lure Conha or PerFormin Installatio �, Phone No. ^�
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A 11 8/96 gOARD COPY - SEE INSTRUC710NS ON BACK OF YELLOW COPY