P - 83867(� REQUEST FOR ELECTRICAL INSPECTION - �..
4 �J J- 716 � 8121 Uniaersity A ear Rm. Se128, ISt. Paul, MN 55104
Phone (612) 642-0800 ���
Home Duplex Apt. Bidg. Other: New Addn
Commercial Industrial Farm Remod Re air
Air Cond. Htg. Equip. Woter Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" ov t work covered by this request. Enter remarks in this s e and on the back of the wh' copy only.
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Calculate Inspec►ion Fee - This spection Request will n be accepted wirhovt 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 Siq. Above 200 Amps Above 100 Am
Transformer/Generator INSPECTOR'S USE ONLY TOTA
Sign/Outline Ltg. Xfmr.
'Remote Control
iing Pool
I hereb certi rhat I
�n Boom Rough-In
I Inspecti , „ _ / -�,
installation described herein on the dates stated
Fee
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Investigative Fee � � - � _ � ,�_�` �"�` �/J -y�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MON7HS.
OPFICE USE ONLY This request void 1 8 monfhs from validafion dafe prinfed in fhis box.
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* D 4� 9 7 1 6 7%� PLEASE PRINT OR TYPE �� �i�
Request Date Rou h-in ins tion r uired?
,Q �� g pec eq ❑ Yes No Inspection Other Than Rough-In: Ready Now ❑ Will Call
(You must call the inspector when ready� Dafe Ready:
I, icens d conhactor ❑ owner hereby request inspection of the above electrical work at:
1 b�d� s �Sfreet, Box, or oute No.) ^ � City �' �. � Zip Code
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Secfion Na
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or No. I Range No. I Fire No.
Power Supplier �
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Electric ontracfor (Com any Nar�{
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Mailing Addr . (Conhactor or Owner
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Authorize ature (Conhacfor o
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Address
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'erfo_ rming Insfallation)
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BOARD COPY - SEE INSTRL
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Phone No.
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Controrfor License �N/o.�,J Master
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Phone No.
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