P - 81123-` REQUEST FOR ELECTRiCAL INSPECTION �°'&
C� � 1- 8 5 6� 8121 University Ave. r Rm. S-128, ISt. Paul, MN 55104 �'
Phone (612) 642-0800 `'�'
}(: Home Dupiex Apt. Bidg. Other: New Addn
Commercial Industrial Farm Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmf. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by ihis renque `t.�/�\r.em�ks in th"s s(a�ce and on the back of the white� pY��
�'� t.J �„`,ts�: �Y� \� �
Cakulale lnspectiort Fee - This lnspecfion Reques► will not be accepied without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps .�
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY ��-Z; TO� �
Sign/Outline Ltg. Xfmr. " ^�"
Alarm/Remote Control
Swimming Pool
I hereb certi thot I ins the elechical installaKon described herein on Ihe dates stoted
irrigation Boom Rooyh-I„ par�
$pecial lnspec
Fin61 Dafe
Investigative Fee
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
... ... OFFICE USE ONLY This requesf void 18 months from validaFon dafe printeci in ihis box.
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* 0 8 2 7 8 5 6 6* 7�vJ`�� -
PLEASE PRINT OR TYPE
Request Dafe Rough-in inspection required$ ❑ Yes �' lo Inspection Other Than Rough-In: �eady Now � Will Call
,�.. �� � �`(ou musf call fhe inspecfor when ready) Date Ready:
I, �censed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sheet, Box, or Route No.) City Zip Code
�S�-t \ y ,
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Secfion No. Township Name or . Range No. Fire No. ounty .
�.L�
Occupanr Phone No.
(L-4�... \ �oli -7SY-1Y3
Power Supplier Address
Electrical Conhactor (Company Name� Conhador Liceose No. Master Lic. No. (Planf Elect. Only)
� c,�--a a3 b S�
Mailing Address �Conkactor or Owner PerForming InsTallafion)
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uthorized Si ooh r ner e I Ilati „ Phone No.
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EB-000 A-i l 8/96 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY