P - 81272q REQUEST FOR ELECTRICAL INSPECTION �""'�"��
6! �� o�- 1� 8121eUnivessry Ave. r Rm. Se12r6,'St. Paul, MN 55104 ���'
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. Phone (612) 642-0 Q� �� �`?��:�
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Home Duplex ApL Bldg. Ofhec . New Addn
Commerciol Indusfrial Form Remod Re air
Air Cond. Hfg. Equip. Water Hfr. Load Mgmt. Ofher.
Dryer Ronge Elec. Heot Temp. Service
"X" above �he work covered by this reques/ En�er remarks in this spoce ond on fhe back of t6e while copy only.
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Calcula�e (nspecfion Fee - rhis lnspecfion Requesf will nol be accepfed withouf the mrrect fee:
Other Fee p Service Entrancc Size Fee # Circuits/Feeders Ft
Mobile Home Pork Stall 0 to 200 Amps 0 to 100 Amps
Sireet lfg./Tmffic Sig. Above 200_Amps Above 100_Amps
Tronsformer/Generator INSPECTOH'SUSEONLY TOTAL �ja Sb
$ign/Oudine Ltg. Xfmr.
r�
Alarm/Remo�e Conhol
� $wimminy Pool I hereb cen� �har I ��s ected rhe elxnica ' sollato� descdbed herei� on the daies smied
. �ffl9Ofi00 BOOm RougMn � �^ _
Speciolinspec �. - "�
Flnol
Invesfigative F e% f ,L.
THIS I„NSTA�LATION MAY BE ORDERED DISCO ED IF NOT COMPLETED WITHIN 18 O S.
�� IIIII Iilllillll il IN�Mi�ll III II NI IINI II� OiFICE USE ONLY This request void 78 �rom validaFan dare prinfed in Ihis 6ox.
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PLEASE PRINT OR TVPE
Request_Daa Rough in inspxiion required? ❑ No Inspenion O�her Than Roogh In: ❑ Ready Now Will Coll
.� �' � �You m�.� call �he mspecbr when readyl Date Ready:
I, �,�.licensed contmcfor ❑ owner hereby requesf inspecfion of fhe a6ove elecfriml work at
Jo6 Address ISheN, Bo., or Routa No.l Gy � �/ Zi� �� �
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Setlion No- Tawnship Name ar No Range No Fre No. Couny
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EBOOOOIAI I 8/9fi E BOARU COPY- SEE WSTIiUCiIONS ON BACK OF YELLOW COPY