P - 83988REGIUEST FOR ELECTRICAL INSPECTION �
5 6 2= 913 � in821 University A ea,rRm. 8e128,ISt. Paul, MN 55104
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_ 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:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on ►he back of the white copy only.
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Calculate Inspection Fee - This Inspection Request will not be accepted without ►he correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL �
Sign/Outline Ltg. Xfmr. ��
Alarm/Remote Control
$wimming Pool
I hereb certi that I ins ted the elecfrical installation described herein on �e dates stated
Irrigation Boom ' Rough-In Dafe
Special Inspection
Final Daf _ ^ Q�
Investigative Fee -� �r'
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 1 S months from validation date prinfed in this box.
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PLEASE PRINT OR TYPE
Request Date Rough-in inspection required? ❑ Yes ❑ No Inspection Other Than Rough-In: Ready Now ❑ Will Call
'�O '�' (You must call the inspector when ready) Date Ready:
I, �icensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (St eet, Box, or Route No.� City Zip Code
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Secfion No. Township Name or No. Range No.' Fire No. Cou �
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Power Supplier j /� , �
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Electrical Confracfor �Company Name)
DEPEN
M1�tl�d`�id�li�'k`�°�pl S°��V
Ceon Rapids, MN b54
Aufhorized Signature (Con ne
Pho� � q3��
License No Master Li No. (Plant Elecf. (
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� Phone No.
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BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELL0IA'6QEY