P - 81786REQUEST FOR ELECTRICAL INSPECTION w
CJ t,� `� = 2 5 5� M821 University A ear Rm. S-128,ISt. Paul, MN 55104 �'
Phone(612)642-0800
Home Duplex Apt. Bldg. Other. l 6O �'7 New Addn
Commercial Industrial Farm l„s Remod Re air
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 this space and on ihe back of the white copy only.
Calculaie Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # Service Entrance ize Fee' # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 00 Amps Q 0 to'100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR•s usE oN�r TOT$L ��T
Sign/Outline Ltg. Xfmr. U
Alarm/Rem I
Swimming
I hereb ceni that I ins the eleclrical insmllation described herein on the dates stated
Irrigation Boom RougMn Date
Special lnspection
Final Da�` 2(G`d
Investigative Fee / i
THIS INSTALLATION MAY BE ORDERED DISC ECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFlCE USE ONIY This request void 18 monfhs from validation date prinfed in fhis box.
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PLEASE PRINT OR TYPE
Request Dafe Rougltin inspecfion required2 ❑ Yes �No Inspection Other Than RougMn: ❑ Ready Now Will Call
��/b ! (You must wll the inspecfor when ready) Dafe Ready:
I, ❑ licensed contractor owner hereby request inspection of the above electrical work at:
Job Address �Street, Box, or Route o.� City Zip Code
.7 �G (,,/ � l�Lt. Y S'SY3Z
Section No. Township Na or No. � Range o. Fire No. Couny
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Occupant ���� �% � Phone N�� � � � ' �� ��
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Power Sup lier . Address
�' �rH��jov�rS �t%dKZ"C� °
Electrical Conhacror m ny Name) �^ Conkactor License No. �Master Lic. No. (Plant Elecl. Only)
Gi� `�
Mailing Address (Conkactor or Owner PerForming Insfallafion)
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AWhori $i nalure Con r or Owner Performing Insiallafion) Phone No.
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E 1 A-11 S/96 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY