P - 82926REQUEST FOR ELECTRICAL INSPECTION _
�%�L �� V 1�� 8�21 Universrty A ea�Rm. S-128,�St. Paul, MN 55104
/ Phone(612) 642-0800 ' '
. nma Dunlex Aot_ Blda_ Other: NeW Addn
Commercial Industrial Farm od 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 the white copy only.
�T S/s�Z C�L� � 'J E� j Z C% Ci A f
Calculaie Ins ction Fee - This Inspection Request will not be accepied without the cornect fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Sheet Ltg./Traffic Sig. Above 200 Am s Above 100__Amps
Transformer/Generator INSPECTOR�S USE ONLY TOTAL� �ii
Sign/Outline Ltg. Xfmr.
Alarm/Remote Conhol
Swimming Pool
I hereb certi that I ins the elech'icol installafion deuribed herein on the dates stated
Irrigation Boom Ro„9�.i„ pare
Speciallnspec '
� ' Final , �� � �
Irnestigative Fee
THIS INSTALLATION MAY BE ORDERED DISCONNEGTED IF NOT COMPLETED WITHIN 18 MON S.
OFFICE USE OWIY This request wid 18 months from validation dafe printed in this box.
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* 0 6 2 6 8 7 1 8 * 3���
PLEASE PRINT OR TYPE
Request Dafe RougfFin inspecfion required? ❑ Yes InspecKon Olher Than Rouglrin: [�1leC�FJow 0 Will Call .
� � y�► 5� �You must cali fhe inspector when ready) Date Ready:
I, ' icensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Streef, Box, or fe No.) , Ci - Zip Code
C� `f� /-e� � �c, f La
Section No. Township Name or No. Range No. Fire No. C uny
J��u�/�-
Occu ant % Phone No. �
U ` T / / i �/�\/v � �/
Confractor
o�
=onhactor License No.
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COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY