P - 79437n REQUEST FOR ELECTRICAL INSPECTtON ���"�_,
p O L� L�1 �� 8121 Univers ry A ear Rm. S1e12r8, ISt. Paul, MN 55104 ��
Phone (612) 642-08 -
Home Duplex Apt. Bldg. Olher: � New Addn
Commerciol Indushial Farm Remod Re air
Air Cond. Hlg. Equip. Woter Hfr. Load Mgmt. Other:
Dryer Range Efec. Heol Temp. Service
"X" above the work covered by this requesf. Enler remarks in Ihis space and on the back of the white mpy only.
Calculofe Inspechion Fee - This Inspec�ion Requesf will nof be accepled withouf �he correc� fee:
Other Fee # Service Entrance Size Fee # Circui[s/Feedere Fee
Mobile Home Park Stall X 0 1 20 Amps � 0 to 100 Amps
Streei Ltg./TraHic Sig. �Above 200_Amps Above 100_Amps
Transformer/Generaior INSPECTON'S USE ONLY TOTAL /�
Sign/Oudine Llg. Xfmr.
Alarm/Remote Control �
SwimmingPool �-� . ��^ ��� (
' . 1 hereb cenl thar I I�r eoed �he elenric '�ns�alla�lon descrlbed h' dares staied
Irrigation Boom t3,f o„9Fd„ me
Specia�lnspecfion �
a,.� ,. �c 3-o r
Final �
Invesligative Fee — ��— dZ
ITHIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 16 MONTNS.
OFFlCE USE ON�Y This reqoest void 18 monlhs 4ram validalian dafe prinred in Ihis box.
I I�II I II II III I�I II II II � I II I II III II I I I I�II Q
* 0 8 0 2 2 9 2 3 s �, �2�6/ ,L�� �d
PLEASE PRINT OR TYPE
Reques� Oare � Rwgh-in inspxnon reqoired2 es ❑ No Inspeclion Other Than RoigMn: ❑ Ready Naw Will Call
// — — d/ (Vo� mos� mll the inspx�w whe� rcndy� Dok Ready:
I, ❑ licensed conhoctor �wner hereby requesi'mspection of the above eleciricol work al:
lob Address �Sireet, Bo., or Rwle Na.� Ciy Zip Code
�� � 2, c� G� c/� �/� a� F�-. :f/��j Ss�/,3
Senion No. Township Name or No. Ronge No. Fire No. Counry
D `� � �; `� 2 �lo %��a•�!9-
oc<vPanr r Phane No.
N/ea , .% .C/Y� �a 7�3 - �/- �/S.�
Power Supplrer Address / � //
L° C �f /J� ' / �! r7 i j'�'1 �! �J �
Elenriml Co mct« �COmpony Name) Cootro<ior Gce�se No. . Mosrer tic. No. (Plonf Elec! Only�
Cil� `� ✓�
Moiling Address �Conhocror or Ow�er Perfarming Insmllmion)
3"m � .Q. � � C„�� � -
AWMrized Sig�amre �yn¢a�ro. or Owner PerlormingJ}smllmlo�) _ Pho� No.