P - 82992� RE(�UEST FOR ELECTRICAL INSPECTION �
6 V�-12 5� in821eUniversity A earRm. S-128,ISt. Paul, MN 55104
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Phone (612) 642-0800
Home Duplex Apt. Bldg. Other: New
Commercial Industrial Farm Remod
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 the back of the white copy
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Calculate Inspection Fee - This Inspecti equest will not be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR�s use oN�r TOTAL
Sign/Outline Ltg. Xfmr. �
Alarm/Remote Control
Swimming Pool
I hereb certi that I ins � the elechical installation described herein on the dafes stah
Irriaation Boom Rn���hJn ��
j_Investigative Fee —`� `'i v v � - ( I S'—Z—O /
ru�c �n�srei � eT�nN M4Y BE �ROERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFPICE USE ONLY This roquest void 18 months irom validafion date printed in this box.
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* 0 6 0 7 1 2 5 2� �3a /
PLEASE PRINT OR TYPE
Requesf Date Rough-in inspection required$ [i Yes ❑ No Inspecfion Olf�er Than Rouglrin:
� p� ` 9� r'ou musf cnll the inspecfcr when ready) Dafe Ready:
I, licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Jo Address (Skeet,�oute No.) ^ / /j� Ciy���' /�
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Secfion No. I Township Name or No.
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Power Supplier
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����NDABcE ELECTRIC. 1
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Fire No. Co
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Phone No.
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55433
or Owner e rming Installafion) ^�^�� Phone No.
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STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY
I Ready Now ❑ Will Call
Zip Code /
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