P - 82767REQUEST FiDR ELECTRICAL INSPECTION _
6 5 8 p711 � in821 Uni eSsity Ave.,rRm. S-128,'St. Paul, MN 55104
� Phone(612)642-0800 "�'
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Re air
Air Cond(j Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
�b Cla�.iSan 'l �'� -�$�s
Calculate Inspection Fee - This Inspection Request will nof be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street ltg./Traffic $ig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL �
Sign/Outline Ltg. Xfmr. —�
Alarm/Remote Control
Swimming Pool
I hereb certi that I ins ted the elecirical installation described herein on the dates staled
Irrigation Boom RougMo Dare
Special InspecSion; � �Z c �"
Final D(i`g�
Investigative Fee (f '
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
I I� I� Ig� II III I) III I� I OFFICE USE ONLY This requesf void I S months from validafion dafe printed in fhis box.
� i�iiiiiiiiiin�i� � ,��
* 0 6 5 8 7 1 1 °" ��Q 6
PLEASE PRINT OR TYPE
Request Dpfe� ��� Rou h-in ins ion r uved� ❑ Yes No Ins
••+� 9 P� eq ' pection Other Than Roughan: ❑ Ready Now Will Call
� I (You must call the inspector when ready) Dafe Ready:
I, licensed contractor ❑ owner hereby request inspection of the above electrical work ot:
Job Address (Sheet, Box or Roufe No.) City Zip Code
Zo � dar. ri �.1. ,S� �2-
Secfion No. Township Name or No. Range No. Fire No. CounN
I Power
BLAINE H'TiQ. 11�'C Et.EC1:. INC.
Ad pllati
� ANOjt� � 55304
I Phone�� � ` � ��
Conhactor License No. Masrer Lic.
�} �,4 �" Phone
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ONS ON BACK OF YELLOW COPY