P - 82822REQUEST FOR ELECTRICAL INSPECTION
6'-t tJ �� J� � 8121eUniversry A earRm. Se128,ISt. Paul, MN 55104
Phone (612) 642-0800
Home Duplex Apt. Bldg. Other: New Addn
ommercial Industrial Farm Remod Re air
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 the white copy only.
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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 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TO
Sign/Oudine Ltg. Xfmr. �Y �
Alarm/Remote Control
Swimming Pool
I hereb certi that I ins the elechical installotion described herein on the dafes sfoled
Irrigation Boom Rou9Mn Dore
Special lnspec '
F,�o� - i r
Investigative F �"-^�
_ THIS INS7ALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY TAis request void 18 months from validation date printed in this box.
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PLEASE PRINT OR TYPE
R�' ^��� Rou h-in ins ction r uired?
g pe eq ❑ Yes No Inspection Ofher Than Rough-I dy Now Will Call
G(You musf call fhe inspector when ready) Dafe Reudy:
I, icensed contractor ❑ owner hereby request inspection of the above electrical work at:
Jo��D/t Bo���� �`/� Cily //• Zip Code
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Secfion No. Township Name or No. Range No. Fire No. C nty �
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Occupont Phone No. �
Power $u li r Ad� j�� /% �' / O/ �
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Electri o a r om me) `� � Co� Licegse�� Master Lic, No. (Plant Elecf. Only�
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Mailing Addreu (Conhacbr or er Pe ing InsMllation) ��, //�
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Auth ' ed Signo e �Conha or Ow er P rm' I' n� /�
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6 STATE BOA ' C Y- SEE INSTRUCTIONS ON BACK OF YELLOW COPY