P - 80905(j('� RE�UEST FOR ELECTRICAL INSPECTION �"
8 �+ J-14 4 � B121eUnivessaty AvearRm. Se128,ISt. Paul, MN 55704 ��,
� Phone (612) 642-OB00 ,�.
Home Duplex qpt. Bldq. Other: .,_.. .,�
��r� � nrr. �ootl Mgml. Oiher.
Elec. Heo� Temp Serv2e
by fhfs request Enfer remorks in fhis space ond on
Cakulofe Inspecfion Fee - This InspE
Other Fce
Mobile Home Park Stall
Slreet Lig./Troffic Sig.
Tro nsformer/Generofor
$ign/Oufline Lfg. Xfmr.
Alarm/Remote Control
Swimmin Pool
IrriQafion Boom
m Requesf will not be occ�
# Service Entrance Size
0 to 200 Amps
Above 200_Anp
INSPECTOR'S USE ONLV
withouf the mrrect fee:
�ee # Cirwits
Oto IODA
Above 100
copY
dotes
Fee
i rns insTALLATION MAY BE ORDERED DISCO NECTED IF NOT COMPLETED WITHIN ia nn�uTN I
OFFICE USE ONLY ihis reqoesl wid I 8 momhs fmm validation daie primed In this 6ox.
�RI� IIIIN�INiIIII���lillilh�ili������Ni � °�o "��
* 0 8 0 9 1 4 4 9* Jr�o2 7
PLEpSE PRINT OF TYPE
Request Dole Roogh in Inspenion reqoiredR ❑ Ves No Inspxtion Other Thvn RoughJn: Ready Now � Will Call
��7 � Ivoo m�sr coll ihe ��specror when .eady) Daie Reody; �� 1_
I, �� licensed coniracfor � owner 6ereby requesl inspection of fhe above elethical work at:
Job Address (Srveei, Bax, or Rauie NoJ Ciy Zlp Code
i0�-<il.�.S'tetr %1 �E 8�v� �✓i��eY
L�wian LevY.�e
ower Supp ier
edncol Commcror (Compony Name)
�TS �LECTiQ/G
la�ilinyg Aded�re�xs (Canvac�o� or� yOwn'eJr Performing
li /�V '� /T~ �V�
Nhp;zed Signamre ICo�rtocror ar Owrier PerY[
�°� . �rC
OODOIA-118/96 STATEB
/4N0 �
Phone No.
S'�/ -3o6S
SS3 9�
.c..� I c
SEE INSTpUCT10N5 ON BACK OF YELLOW COPY