P - 80707RE(�UEST FOR ELECTRICAL WSPECTION
7�� �� 7 9 9� S121 UniversiYy A earR pf SIe128 �St. Paul, MN 55104
Phone(612) 642-0800
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial 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.
Calculate Inspection Fee - This Inspection Request 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 Lfg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
Sign/Outline Ltg. Xfmr. �
Alarm/Remote Control D S
Swimming Pool
I hereb certi ihat I ins the electrical installation described herein on the dates stated
Irrigation Boom RougMo Da
Speciallnspecti �2� �
Final Da
Investigative Fee
THIS INSTALLATION MAY BE ORDERED DtSCONNECTE IF NOT COMPLETED WITHIN 18 MONTHS.
_ _ _ __------�------,��
OFFICE USE ONLY This request void 18 monfhs bom validafion dafe printed in this box.
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I II� II III II +al �I I� III II III I� (� I) �I� J�) pLEASE PRINT OR TYPE ����
RequesT te R u h-i ins ection e u d? es
g p q ❑ No Inspection Other Than Rough-In: ❑ Ready Now ❑ Will Call
sZ? � (You must call the inspecfor when ready) Date Ready:
I icensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (S � x, or Roufe No.� -- City - Zip Code
!D vrR✓ ^ iRrP�9�C'C� ^'I�«'
ecfion No. ownship Name or No. Ranae No. Fire No. Coun �
� Occupanf
Phone No.
�
Name)
Owner Performin Insfallofion) -
ifi � •
�r or Owne� Perfordna I ollafionl
Lic.
�o ,.� �S/•7,� 03,
BOAHD COPY - SEE INS7RUCTIONS ON BACK OF YEILOW COPY