P - 82949REQUEST FOR ELECTRICAL INSPECTION
�� O° 0 61 � 8121 Uni ess ty Ave.,r Rm. Se128,'St. Paul, MN 55104
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% Phone(612)642-0800
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above ihe work covered by this request. Enter remarks in this space and on the back of 1he 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
Mobile Home Park Stall 0 to 200 Amps 0 to 1 0 Amps
Street Ltg./Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL �O
Sign/Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
I hereb certi that I ins fhe elechical insfallation described herein on the dafes stated
Irrigation Boom Rough-In Date
Special Inspe
final D
Investigative Fee
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WIT IN 18 MO THS.
OFFICE USE ONLY This requast void 18 months 6om validation dafe prinfed in this box.
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PLEASE PRINT OR TYPE
Reque Dafe •� Rough-in inspecfion required$ ❑ Yes No Inspection Ofher Than Rough-In: ❑ Ready Now Will Call
(You must call the inspector when ready� Date Ready:
I, ` licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sheet, Box or Route No.� Ciy Zip Code
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Secfion No. Township Name or No. Ranpe No. fire No. CounN
Elechical Conhacfor �Company Name)
Eill�#�C�GT-. �.
Mailing Addre ion�
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Authoriz anature 1 nKac Owner PerFo�nina Installc
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ON BACK OF YELLOW COPY