P - 81314y
REQUEST FOR ELECTRICAL INSPEC710N ��'=�
7��- 9� 9� 8121eUnivess ry Ave. r Rm. S1e 28, ISt. Paul, MN 55704
' Phone (612) 642-0800 �?�m.±�
Home Duplez Apt. Bldg. Other: New Addn
Air H}g. Equip. Water Hfr. Load M
ryer Range Elec. Heat Temp. :
"X" above Ihe work covered by this requesG Enfer remorks in
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Calculale lnspec}ion fee - 75is Inspection Reques� will no� be
Other Fee # Service Enhance
Mobile Home Pork Sfall 0 to 200 Amps
Stree} Ltg./Troflic Sic. Above 200_.
Transformer/Generalor INSPECTOF'S USE ONLY
space and on
without the correct fee:
Fee k CircuiL
0 l0 100 P
Above lOC
copy
Fee
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Swimming Pool I hereb ceni ihdi I t�s eckd ihe eled.iwl mnolla�ion descebed harein an ihe dares smiad
Irrigofion Boom .. �„g�t� ome
Special Inspecti
Fnal D e
Invesligafive Fee
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONT S.
__�__._—_..—_..–_—___. _.. .___. ___.--_�—. .—_._—.—_._.__ _
OFFICE USE ONLY This request void 1 B monllislmm volldafior. dare prinYed in ih!s bon.
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PLEASE PRINT OR TYPE
Requss� te Rough in irepxtion requiredx ❑ Yes No Inspenion Oiher Than Roagh�lm Ready Now 0 Will Coll
(Vou m�:i call ihe I�specror when reody� Da�e Reody:
I,�licensed <onfroctor ❑ owner hereby request inspeclion of Ihe above eiectrimV work oY.
1�dress IS�eq eo.,,5� Rome No_I Ciy Z;p Code
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Searian No. Townshlp Name or o. Range No. Flre No. Co
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