P - 81267RE�UEST FOR ELECTRICAL INSPECTION � `�
7��- 5 2 9� 8'21eUniveSta� AVOarRm. 3e128,'SL Paul, MN 55104
Phone (612) 642-0800 �i��,
Home DuPlez Apt. Bldq. Other: New Addn
Air Cond. Hfg. Equip. Water Hfr. Load Mgmt Other,
Dryer Range Elec. Heaf Temp. Service
"X" a v the work covered by fhis request Enfer remarks in this space and on )he back of �he white copy
�L/f�i /d'ta8/GF �'�t.E"�
�,����
Calcu afe Inspecfion Fee - 7his Inspeclion Requesf will nof be occep�ed wi�houf fhe mrrecf fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders
Mobile Home Park Stall 0 fo 200 Amps 0 fo 100 Amps
Sfreef Lig./Traffic $ig. Above 200—Amps Above 100_Amps
Tronsformer/Generator INSPECTOfl'S USE ONLY TO
Sign/Outline Lig. Xfmr.
Alarm/Remofe Confrol
800m � gaaM� ome
Fee
/ -S�
IInvestigative Fee� •-� D°-Ir,�� ��r-�'�--E,^-z-�— I� ��� 2,f—%�/
THIS INSTALLATION MAY BE ORDEREO DISCONNECTED IF NOT COMPLETED WITHIN 78 MONTHS.
OPRCE USE ONLY This requev void � 8 monihs fmm valida�ion dale prinled in this 6ox.
ll�llllllllllllll�illlllllllllll�llllllllll� • a5.�
*0�305295* �?a6�7
PLEASE PRINT OR TVPE
yoe re Ro�yn-�� ���P�no� ,���.edz ❑ ye, i�,�n�o� o�he, Tha� Ro�yn i�_ u�dy N �o cou
yJ�r � ro� m�,� �an �,e ��,�, whe� �eaa� Da�e Reody:
� '-
icensed canimctor ❑ owner hereby requesl inspectian of the above elecfri<al work at:
> i�dress �SheIN, BOZ, o� RoNe No.� �ily Zip �O(�2
?Y�� 6v �e� 01-�
dion No. Township Name or No. Range No. Fre No. Coan��'�
� 1�� /rJv�"! ��'r'�i � V /v
�O rformirg Insmllofianl Phone No.
,��..__ ��U �n �/i�� i�