P - 82965' REQUEST FOR ELECTRICAL INSPECTION �
V� 1-1 Q 5� 8121eJni essty A ea,rRm. S-128,'St. Paul, MN 55104 �'
Phone(612)642-0800 "�'
Home Duplex Apt. Bldg. Other: New Addn
Commercial Indushial Farm 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 the back of the white copy only.
, �2�yZ�
Calculate Inspection Fee - This Inspection Request will not be accepted wiihout the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Sheet Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
Sign/Outline Ltg. Xfmr. ��•�
Alarm/Remote Control
Swimming Pool
I hereb cerli that I ins ted the elechical insmllation dexribed herein on the dates stated
�ffi9dtiOn Boofll � RougMn Date
Special Inspecti
f1rtEF Da ' Z ^ U /
Investigative Fee 1
THIS 113STALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFlCE USE ONLY This requesf void I B�ifis from vpiidation date printed in this box.
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* 0 6 0 7 1 0 5 4* /��Oo�
PLEASE PRINT OR TYPE
Request Da�e � Rou h-in ins fion r uired? �i Yes
/� �� g pec eq ❑ No Inspecfion Other Than RougMn: Ready Now � Will Call .
rou must call the inspec�cr when ready) Date Ready:
I, �censed contractor ❑ owner hereby request inspection of the above elechical work at:
Job Address Sheef, Box, or No.) Ci Zi Code � -
�9�1 v � � y ,��� P :.�.�
Sechon No. Township Name or No. Range No. Fire No. Couny
/1G
Occupanf` n n _ Phone No.
on Rapids, MN �.5433
Ihorized Signa}ure (Co cfor or Owner Pe
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COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY
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wster Lic. No. IPlant Ele�
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