P - 84417dj ' RE�UEST FOR ELECTRICAL INSPECTION �`;°..
�1 I�I ��(I (II I) III II III II III (I III II (II (� III (��II 8121 Un eSsateAvearRmf 3 1281cSt. Paul, MN 55104 +:.'
� 0 2 9 9 3 3 7 6* Phone (612) 642-0800
� Home Duplex Apt. Bidg. Other. �/L (� New Addn
Commercial Industrial Farm � = Jc� Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. O hJelr:. / % /�
D er Ran e Elec. Heat Tem . Service �API�'�"1 iC' f�f �E�KTIt'�" �'��
"k' above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
Calculate Inspection Fee - This Inspection Request will not be accepfed without the correct fee:
C)ther ' Fee # Service Entrance $¢e Fee # Circuits/Feeders
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic $ig. Above 200 Amps Above 100 Am
Transformer/Generator INSPECTOR'SUSEONLY TOTA
Siqn/Outline Ltq. Xfmr. Lac•�=�1 Cs-�----� ��'����° `�
�
Fee
S�
$wimming Pool
� hereb ceAi that I ins ecied the eledrical insMllation described herein on The dafes sTated
Irrigation Boom Rough-In Date
$pecial Inspedi � � '�
Investigative Fee f���� �__ ��"- '� —j �_��
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
2 9 9- 3 3 7� OFFICE USE ONLY This request void 18 months from validafion date pnnted in this box.
�1
PLEASE PRINT OR TYPE � �` � �� � — " �
Request Date Rough-in inspecfion req�ired2 es ❑ No Inspeciion Other Than Rough-In: � Ready Now ill Call
% j.� �6 y (You must call ihe inspedor when ready) DaTe Ready:
I, ❑ licensed contractor � owner hereby request inspection of the above electrical work at:
Job Ad�l �j�Street, By�c,r� � ufe Ng,��C E'� ,� City / Zip Code 2
�l ` ��/ � � /-liC.+f . �.�, d �� s � 5%�
$edion No. Township Name or No. Range No. Fire No. County
Occu T
�'���
Power $upplier
�v s �
3� �. ,���/.�
� Phone No.
�s�,� /�" �z- �7-z - Y� .��
nad�es5
2R�.
� Name1 � Conhador License No. Master Lic. No. (Plant Elecf. Only)
Mailing Address f jpniraclor or Owner Performing InsMllation)
Owner Performin sfallafion) 2 4$10 P� � o. � ��
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STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY