P - 81253(� p REQUEST FOR ELECTRICAL INSPECTION � �<
7� l�' aJ � O � 8121 Univers ry AVear Rm S �Z8 ISt. Paul, MN 55104
Phone (672) 642-OB00 �!.�.�
Home Duplex Apl. Bldg. Other: New Addn
"X" above fhe work covered by fhis requesG Enfer remarks in fhis spoce and on lhe back of rhe whi�e copy only.
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Ca cula/e pecfion Fee - This InspecYion Reques� wilf nol be occepled withou� the correct fee:
Other Fee k Service Enhance Size Fee M Circuits/Feeders Fee
Mobile Home Park $tall 0 to 200 Amps 0 l0 100 Amps
Sireef Lfg./TraHic Sig. Above 200_Amps Above 100_Amps
ine Ltg. Xfmr.
mofe Confrol
� Pool
Boom
INSPEGTOH'S USE ONIY
ihailinso ted �he
Date
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'HIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WRHIN 18 MONTHS.
oFFICE USE ONLY This request void 18 manths 6om validarlon dme printed in thls 60:.
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PLEASE PRINT OR TYPE
,p°� % ^�� Roughin �inspec�ion required? ❑ Yes Inspxfion O�her ll�an Naugh�ln� ❑ Ready No Will Coll
y�Yo� m�:� ca',I �e inspecro� when ready� pak keady:
licensed controctor ❑ owner hereby request inspection oi the obove electrical work ot:
�ss ISneer, Box, or Route No.l GN Zlo Code
�nfmctor �Compony Name�
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Iress �conrcocror or Owner
or
Fre No.
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