P - 80354REQUEST FOR ELECTRICAL INSPECTION
8��-191 � 1n821 Universty A ear Rm. S-12r8, I St. Paui, MN 55104 �
�. ' Phone (612) 642-0800
Home Duplex Apt. Bldg. 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 reques�. Enier remarks in this spoce and on the back of ihe 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/Outline Ltg. Xfmr. �� �
Alarm/Remote Confrol
Swimming Pool
I her certi thw I ins ed the elechical inslallation described herein on ihe dales sla�ed
Irrigation RougMn Dare
Speciall i
Final Dote
Investigative Fee
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validafion dafe prinfed in this 6ox.
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PLEASE PRINT OR TYPE
Reqvesf Dat Rough-in inspection required? ❑ Yes tnspection Other Than RougMn: ❑ Reody Now ill Coll .
� � (You must call the inspecfor when ready) Date Ready:
I,�icensed contractor ❑ owner hereby request inspection of the above eiectrical work at:
1ob Addrexs (Sheet, Box, or Rouhe No.) City Zip Code
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Section No. Township Name or No. Range No. Fire No. Couny � �
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Occu Phone No
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acfor �Compan Name� Confractor license No. Master Lic. No. (Mant Elec1.
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�s (Conhacfor or Owner Perfofming InsfallafiooJ � .
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(Conhactor or Owner 1�� ilafion) Ph� o.
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8/96 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY