P - 84183t— REQUEST FOR ELECTRICAL INSPECTION
���_�� O � 8121 University A earRm. SI 128,ISt. Paul, MN 55104
Phone (612) 642-0800
Home Duplex Apt. Bldg. Other: New
Commercial Industrial Farm Remod
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Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in ihis space and on the back of the white copy only.
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Calculaie Inspection Fee - This Inspection Request will not be accepied without the correct fee:
Other Fee # Se 'ce Entrance Size Fee # Circuits/Feeders
Mobile Home Park Stall to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Amps Above 100 Amp�
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
Fee
�ign/VUnine Ltg. Xtmr. I t5�
Alarm/Remote Control
Swimming Pool
I hereb certi thaf I ins the elecfrical installation described herein on ihe dates stated
Irrigation Boom Rough-In D te
Special Inspection � - ��"� ��
Investigative Fee , ` F���I � � ;�z-�-��__ �� ' � �. ,;' � :
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requesf void 18 monihs from validafion date prinfed in fhis box.
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Request Date ,' / Rough-in inspec}ion required2 es
�� ❑ No Inspection Other Than RougMn: ❑ Ready Now ilI Call
f��' ,; j--' � r, (You must call ihe inspector whe rea � Date Ready:
I, �censed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address �Streef, Bo�pr Route No.) Ciy Zip Code
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Section No. Township Name or No. Range No. Fire No.
Occupc}pf�
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Power Supplier �%
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Elechical Conhact (Company Name�
Mailing Address (Confractor or Owner Pe
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STATE
Address
Phone No.
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License No. I Master
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Phone No.
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