P - 80837REQUEST FOR ELECTRICAL INSPECTION �
7",� _��" � 8'21 Universty A ea,rRm. S-128,'St. Paul, MN 55104 �'
s � Phone (612) 642-0800 `'�'
ome Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Re air
Air Cond. Htg. Equip. Water Hir. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
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Calculate Inspeciion Fee - This Inspecfion Request will noi be accepfed withouf fhe 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 TOTA �
Sign/Oudine Ltg. Xfmr. �
Alarm/Remote Control
Swimming Pool
I herebvi certiH that I insoected the electrical inslallafion dexribed herein on the dafes stated
Investigative Fee ` v ..�� '� y� ��v
THIS INSTALLATION MAY BE ORDERED DISC CTED IF NOT COMPLETED WITHIN 18 MONTHS.
. OFFICE USE ONLY This requesf void 18 months from validation dafe printed in this box.
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PLEASE PRINT OR TYPE
Requesf Dafe Rough-in inspecfion required? �� es ❑ No Inspection Other Than Roughan: Rea Now � Will Call
I� � �You must call the inspactor when ready) Date Ready: /—
1, �licensed confractor ❑ owner hereby request inspection of the above elecfrical work at:
Job Ad reu (Stp�et Box o No.) Ciy Zip Code
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Seclion No. Township Name or No. Range No. Fire No. C
Occupant / Pfrone No. `
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1 Power
�// I ConhaFfor License No. I Master Lic. No.
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or Owper Pe minr/ Installationi
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Instal � ^ �
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COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY