P - 81227� REQUEST FOR ELECTRICAL INSPECTION
c1 1�—�. 9 6 � S121 University Avea,rRm. SI 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:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on the back of ►he white copy
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Calculate Inspeciion Fee - This Inspection Requesi will not be accepied wifhout ihe corr fee:
Other Fee # Service Entrance Size Fee # Circurts/Feeders
Mobile Home Park Stall to 200 Amps 0 to 100 Amps
Stre t. 'c Sig. �/. (i 0 Above 200 Am s ,� Above.LA9" vAmps
/ Generator INSPECTOR'S USE ONLY TOTAda,
Sign/Outline Lfg. Xfmr.
Alarm/Remote Control
Swimmina Pool
I herebvi certifv that I
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the elechical installafion dexribed herein on fhe dafes sfated
Investigative Fee � ���� � %(9 — G
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requesf void 18 monfhs from validation dafe prinfed in fhis box.
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PLEASE PRINT OR TYPE
Requesf Date� �� Rough-in inspecfion required� ❑ Yes o Inspection Ofher Than RougMn: �] Ready Now ill Call
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/ �You must call the inspecfor when ready) Date Ready:
I, ❑ licensed contractor ❑ owner hereby request inspection of the above elecfrical work at:
!ob Addres (Street, Box, or ule No. < Ci
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or No.
or Owner
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No.
Phone No.
Masfer Lic. No. �Plant
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STATE BOA D COPY - SEE INSTRUCTI BACK OF YELLOW COPY