P - 82308REQUEST FOR ELECTRICAL INSPECTION
8��� 215 � g121eUni essty A ea,rRm. S-128,ISt. Paul, MN 55104
< Phone (612) 642-0800
Home Duplex Apt. Bldg. Other: New
Commercial Industrial Farm Remod
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
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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
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Sfreet Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
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Addn
Fee
Transformer/Generator INSPECTOR's USE ON�Y TOTAL
Sign/Outline Ltg. Xfmr. � ' �
Alarm/Remote Control
$Wimmin9 Poo� I herebvi cerli(y thot I inspected the electrical installotion described herein on the dates stated
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Investigative Fee
THIS INSTALLATION MAY_BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requesf void 18 months 6om validafion dafe prinfed in ihis�box.
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PLEASE PRINT OR TYPE � �
Requesf Date Rou h-in ins ection re uired?
g p q ❑ Yes No Inspection Other Than Roughan: ❑ Ready No Will Call
�� � �You must call the inspecfor when ready) Date Ready:
I, �icensed confractor ❑ owner hereby request inspection of the above electrical work at:
Job Addreu (Sheer, Box, or Roufe No.) Cify Zip Code
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Secfion No. Town:hip Name w No. Range No. Fire No. County
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Mailing Address
or Owner Performing
Phone No.
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No. Master Lic. No. (Plant Elecf. (
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-� Phone No.
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� � a�96 � STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY