P - 82662RE�UEST FOR ELECTRICAL INSPECTION �c���6
� I IIII II ��I II III II I�I II III II III II III II III II I�� I I�II 8121 Uni e sity AvearRmf S-128cSt. Paul, A9N 55104 `�� u.�k
* 0 3 0 6 7 7 1 7 * 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:
D er Ran e Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this spoce and on the back of the ite copy only.
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Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Olher Fee # Service Entrance Size Fee # Circuih/Feeders Fee
Mobile Home Park $tall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic $ig. Above 200 Amps Above 100 Amps
Trans{ormer/Cienerator INSPECTOR'SUSEONLY TOTAL �
$ign/Outline Ltg. Xfmr. (�i •
Alarm/Remote Control
Swimming Pool
I hereb certi that I ins eded the eledrical installation described herein on ihe dates stated
Irrigation Boom Rough-In / Dote /_ r �
$pecial Inspedi <<� � �
Final Dat
Investigative Fee Z � V " �.�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
3 0 6- 7 71 0 OFFICE USE ONLY This request void 18 months from validation date printed in ihis box.
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PLEASE PRINT OR TYPE
Requesf Date Rough-in inspedion required2 '�Yes � No Inspecfion OtherThon Rough-In: � Ready Now � Will Call
/ ��� - 9 y (You must call the inspector when reody) Date Ready:
I, �(icensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (S}reef, Box, o��N� .) j C/�� � J� Ci�, � Zip Code
(� / L C� ! ) F _ /� SS �
Secfion No. Township Name or No. Range No. Fire No. unw
I Occupont � � "� � � �
Phone No.
�tvn,�,. �},�U� S7�- S � L c�
Power Supplier Address
Eled' I Confrador �Company Name) Contractor License No. Master lic. No. (Planf Elect. Only)
� A ^/C —�c ��r. � � �G C /� v � 5/�-0
Moiling Address (Confrador or Owner Perfortn'n Installafion)�
> 5��� s`��� 11;��:/e �� ���d��- s� Z,
Aufhoriz�Si nafure (C�tr�r or Owner Performing InsfallaA n) � Phone No.
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10 6/95 STATE BOARD Y- SEE INSTRUCTIONS ON BACK OF YELLOW COPY