P - 80941' REQUEST FOR ELECTRICAL INSPECTION �•".�
8 2� -� 14 � 8'21eUniversry p earAm Se�28 ISt. Paul. MN 55104 � �
� Phone i612) 642-0800 °�E �.
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industriol Form Remod Re air
ir Htg. Equip. Water Htr. Load Mgmt. Other.
Dryer Ronge Ele<. Heaf Temp. Service
"X" above fhe work covered by fhis requesf. Enfer remorks in �his space and on the back of the whife copy only.
Se,de�wielLi zz519, F�..aa--ni�-
Calculale Inspeclion Fee - 7his Inspecfion Request will nof be occepted wi�hout �he corred fee:
Ofher Fee # Service Entrance Size Fee # Circuits
Mobile Home Park Stall 0 �0 200 Amps '�(„ 0 l0 100 A
Sireet Ltg./GoHic Sig. Above 200_Amps Above 100
TronsFormer/Genemfot INSPECTOP'S USE ONLY
line Ltg. Rfmc �
�.mote Confrol
3 Pool i he,e �em ma, i m, ��ed �he eie��,moi ��,�aimn� de.«��d he,e�� o� me dor��
Boom a„„�ti.n, n��<
50
Fee
Invesligative F� �'V V .�� ^. ZS^ d�
TFiIS INSTALLATfON MAY BE ORDERED DISC D IF NOT CpMPLETED WI N 78 MONTHS.
OFFICE USE ONLY This reques� wid 18 manths from validotion dale prinfad in rhis box.
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PLEASE PRINT OR TYPE
�°�� �O� Roughin inspection required? ❑ Yes �['] No Inspecnon Other Than Rough�ln: Ready Now � Will Coll
8� t_. �You mostmll�heinspecrorwhen rwdy) Da�e Reody:
I, �licensed controctor ❑ owner hereby request inspecfion of Ihe above elecfricol work at:
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or Owner
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STATE BOAND COPY - SEE INSTPOCTIONS ON BAQ
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Phone No.
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