P - 80924REQUEST FOR ELECTRICAL INSPECTION
��� �- 3 01 � g'27QUniv s ry A ea Rm. S-12r6, ISt. Paul, MN 55104
� . Phone (612) 642-0800 �.�
Air Cond. Hfg. Equip. Water Hfr. Load Mgmt. Ofher
Dryer Ronge Elec. Heat Temp. Service
"X" above the work covered by ihis request. Enler remarks in this space and�en �he 6ack of fhe whife copy onl
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Calculafe Inspection Fee - This Inspecfion equest will not be accep�e Ihout fhe correcf fee:
Otlier Fee ri Service En[rance Size Pee S Circuits/Feeders
Mobile Home Park Stall 0 to 200 Amps 0 ro 100 Amps
Sheef Lfp./TmHic Sig. Abave 200_Amps Above 100—Amps
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INSPECTOWS USE ONLY
�hat I mscened �he elecrcical
Final r—� /
Imesfigative F - � 2 U �—C . ;
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WI7HIN 18 MONTHS.
OFFICE USE ONLY This reqoest wid 18 months hom wlidoiron dare printed in fhis box.
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* 0 J� % 5 3 � 1 7 X pLEASE PRINT OR TYPE
Reques� le Roug6in inspx�lon requiredi ❑ Yes No Inspeciion Olher Tlwn RougMn�
'�� '� g �Vw m�st mll �he inspMOr when ready� Dare Reody:
I, �licensed conhacror ❑ owner hereby request inspection of the obove electriml work at:
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Seciion No- Townzhip Name or
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Occ� I
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Power Supplier
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Eleddml Convac�a �Ca�p Na �
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Nwiling Add s �Conk«tar o.Owner Perkrming Insta
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. IA1 I 8/96 STATE BOABD C
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Phone No-
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SEE INSTRUGTIONS ON
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