P - 82285REQUEST FOR ELECTRICAL INSPECTION
� 2 6- 212 � 8121 Uni essity A ea,rRm. S-128,ISt. Paul, MN 55104
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Phone (612) 642-0800 '��
Home Duplex Apt. Bidg. Other: New Addn
Commercial 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 reqvest. Enter remarks in this space and on the back of the white copy only.
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Calculate nspection Fee - This Inspec�ion Request will not be accepted without the orrect 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/Outline Ltg. Xfmr. �
Alarm/Remote Control
Swimming Pool
I hereb certi that I ins fed the eleclrical installation described herein on the dates stated
Irrigation Bo RougMn Dare
Speciallnsp �
Final Dat�'^ � _ P�
Investigative Fee Q
THIS INSTALLATION MAY BE ORDERED DISC NNfCTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFlCE USE ONLY This request void 18 months from validation dafe prinfed in this box.
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PLEASE PRINT OR TYPE
Re�qu/eJsf te ^ �i ug inEjnspecfion required? ❑ Yes No Inspecfion Other Than RougMn: Ready Now ❑ Will Call
/ �� QV � V us�/call the inspector when read Date Ready:
I, licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sheet, Box, or Roofe No.) City Zip Code
3 .!',j� ,
Secfion No. Township ame or No. Range No. Fire No. County
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Occupanf Phone No.
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o� 4-� �i,a�--a��'-s � �
or Owner Performing�lnstallafion) �(,%
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icfor or e Performing Install ' Phone No.
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STATE BOARD COPY - EE INSTRUCTIONS ON BACK OF YELLOW COPY