P - 83916RE(IUEST FOR ELECTRICAL INSPECTION
5 n� �+ = 4 8 6� in821 Univers� A earRm. S 128,ISt. Paul, MN 55104
Phone (612) 642-0800
Home Duplex Apt. Bldg. Other: New
Commercial Industrial Farm Remod
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Diyer Range Elec. Heat Temp. Service
"X" above the work covered by t�1s rG i��est. Enter emarks "n this space and on the back of the white copy
/�l
��/ L�'�� ��tL% '•
;a.
,�.....
�'`- a
`-� ��1�
� •..
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall � 0 0 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Abo e 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTg� ��
Sign/Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
Irriaation Boom
I hereb certi fhat I ins ected the elecfrical installafion described herein on the dafes sWtsd
R���nh-In Date
.,r....,... .,..,r......_ Final � � / � �/ I� �
Imestigative Fe � ( (�!�- s�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMP�ETED WITHIN 18 MONTHS.
OFFlCE USE ONLY This request void 1 S months from validation dafe printed in fhis box.
� ���) �) II� I� I�) �� ��I �� �) � ��� �� ��� �) ��� � ���)
� ����
* � 5 4 4 4 8 6 4�K PLEASE PRINT OR TYPE t��
Reques afe Rou h-in ins fion re uired?
�_ /r �y� g pec q ❑ Yes No Inspection Other Than RougMn: eady Now ❑ Will Call
��V y � (You must call the inspector when ready Date Ready:
I, ❑' ensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Add�s (Sheet, B� r Route No / City �, Zip Code
�� � Or /i�lr°
Section No. Township Name or No. Range No. Fire No. Cou
Occupant
Address (Conh�for o� Owner
Phone No.
Addre�j/� ///��� /f _ �JQ
CC % � 6L f �
Con ctor Licgnse No. Master Lic. No.
�' �C.� . � C (JC � �/�
n�stallation ��
g I afion�
� `:� �
! COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY