P - 79584.
REGIUEST FOR ELECTRICAL INSPECTION
`� ����� O � 1n821eUnivers ry Avear R pf Se128 iSt. Paul, MN 55104 �'
Phone (612) 642-0800 "�'
�
i Home Duplex Apt. Bldg. Other: � S 1� New Addn
�,
Commercial Industrial Farm ^U � Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Othe . 17
Dryer Range Elec. Heat Temp. Service /yj i`/
"X" above the work covered by this request. Enter remarks in this space and on the back of the whiie copy only.
Calculaie Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
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 ONLY TOT/1L �
Sign/Outline Ltg. Xfmr. ' ��
Alarm/Remote Conhol
Swimming Pool � ��
ere certi at I ins ted the elechical installation described herein on th9�QatesStafed
Irrigation Boom RougMn Da
Special Inspection '� � � 2
Final Da
Investigative Fee — — U
THIS INSTALLATION MAY BE ORDERED DISCONN TED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 monfhs from validation date printed in this box.
II�I I�III Ilill IIIII IIIII IINI II�����I�
* 0 8 0 2 3 2 0 2* ��0�/� �/`�
PLEASE PRINT OR TYPE
Requesf Dafe Rough-in inspection required? ❑ Yes ❑ No Inspecfion Ofher Than Rough-In: ❑ Ready Now 0 Will Call .
(You musf cail the inspecfor when ready) Dafe Ready:
I, ❑ lice ontractor ❑ owner hereby request inspection of the above electrical work at:
Job Address �� t, Bo� Roufe No.� �^ Ci � Zip Code
� % ��� ,_:�/f �� �
a.n
$eclion No. Township Name or No. Range No. Fire No. Cou� A n
Phone No.
/CL � ��-O� � l��/
Elecirical Conkaclor (Company Name� ConhacFOr License No. Master Lic. No. (Plant ElecF. Oi
Mailing Address (Conkactor w Owner Pe,forming Installation) �
n
Auth ' i re (Conh r or Owner Performing Installafion) � Phone No.
?�3 - So 2 -�o.�
1 11 8/96 p� gOARD COPY - SEE INSTRUCTONS ON BACK OF YELLOW COPY