P - 83029REQUEST FOR ELECTRICAL INSPECTION
6 �� n- 8 9 3� in821 Univers� A earRm. S-128,ISt. Paul, MN 55104 -
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Phone (612) 642-0800 '�'
Home Duplex Apt. Bldg. Other: New ddn
Commercial Industrial Farm Remod Re oir
Air Cond. tg. Equip. Water Htr. Load Mgmt. Other. �/1 s'�
Dryer Range Elec. Heat Temp. Service ��
"X" above he work covered by his requesi. 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 wifhout fhe correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR�S USE ONLY TOTAL
Sign/Outline Ltg. Xfmr.
Alarm/Remote Control '
Swimming Pool
I her certi that I ins the electrical installafion described herein on ihe dafes staled
Irrigation Boom RougMn Dare
Speciallnsp �
Investigative Fee � �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
.... OFFICE USE ONLY This requesf void 18 monfhs from validaiion dafe printed in fhis box.
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PLEASE PRINT OR TYPE
Requesf Date � Rou h-in ins ection r uired?
g p eq ❑ Yes Inspection Other Than Rouglrl . dy Now ❑ Will Call
� � (You musf call the inspector when ready) Date Ready:
I, �I'�ensed confractor ❑ owner hereby request i�spection of the above elechical work at:
Job��ss �5tre�, Box,�ou/ �, �� /" � Ciy � Zip C � � �
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Secfion No. Township Name or No. � Range No. Fire No. Counly /1 �
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Occupo � � Phone No.
L�C c.0 Q- � Cc,t� �7 �— « `f"�D
Power Supplier - Address
Electrical Conhacror (Company Name� Conhaclor ticense No. Master Lic. No. (Plant Elect. Only)
s �
Mai ing Address �Conhacfor or Owner PerForming Installafion)
Authorized ignature ntrador or Owner Performing Install 'on) 2�� 2. � Phone Na �
,.(,Q� 181-6200
EB-0OOOlA-11 8/96 �p� � OPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY