P - 81330] REQUEST FOR ELECTRICAL INSPECTION � • •
7.F �� a 5 6� g121eUniv �,a� ABOarRm. Se128,'St. Paul, MN 55104
. � Phone (672) 642-0800 .�,w
Home Duplex Apt. Bldg. Other: New Addn
Commerciol Induslrial Farm Remod Re air
Air Cond. Hfg. Equip. Woter Htr. Load Mgmt Other.
Dryer Ronge Elec. Heaf Temp. Service
"X" above 16e work covered by fhis requ st Enler remarks in this space end on the bock of e whiM copy only.
,U� �-�;�� �s�- ��_
Colculafe Inspeclion Fee - This Insp�
Other Fee
Mobile Home Park Stall
g. Xfmr.
Control
�quest will nof 6e accepted withou� tbe correct fee:
Service Entmnyg Size Fee # Circuits
) to�p,� , 0 to 100 A
INSPECTOR'S USE ONLV
�he elendcol I�smllalion dexribed herein on the dmes smred
Fee
I THIS INSTALLATION MAY BE ORDERED DI�ONNECTED IF NOT COMPLETED WITHIN S8 MONTHS.
OFFICE VSE ONLY This request wid 1 B monfhs frwn volidotlon date printed In rhis box.
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*a��oss��� ��96
PLEASE PRINT OR TYPE
Reqoesl Do�e 4-22-99 a�"9�'"'"'�"��" ,�°1fedz ❑ ve, BNa i�.�ro� oe,e, ma� eo�9�,i,,: Beeadr Now O w�u can
�vo� m�sr �aii me ���peao, wne� ,eadr) oaie s�dy:
I, � licensed confractor ❑ owner hereby request inspedion of �he abave elechical wark at:
Job Address (Stree�, Box, or Rouk No.) Ciy Zip Code
211 Sylvan Lane NE Fxidley
Sec�ion No. Township Name or No. Range Na Fire No. Cauny
Dave Woldzahner
PowerSupplier
Cannexus Energy
Eledrical Comraclor (Company Na
� Malling Address �Commnor ar
PFwne No.
PO Box 279 Ramsey MN 55303
me� Conrcacmr License No_ Mns
Inc. CA0�2749
er Performing Ins�allo�ion�
t NE Suite 1 Blaine MN 55449
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