P - 83861RE(�UEST FOR ELECTRICAL INSPECTION
4�' f'`�"' O 1 � 1n821 UniverstyA earRm. S- 28,ISt. Paul, MN 55104 �'
Phone (612) 642-0800 ���'
Home Duplex Apt. Bldg. Other. New Addn
Commercial Indushial Farm Remod Re air
ir Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by Ihis request. Enter remarks in this space and on the back of the white copy only.
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
Street Ltg./TrafFic Sig. Above 200 Amps Above 100 Ar
Transformer/Generator INSPECTOR'S USE ONLY TOT�
Sign/Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
I hereb certi that 1 ins d the electrical installation described herein on fhe date
Irrigation Boom Rough-In Date
Specia� InspediD� P^' � ,-
Fee
�S�
Investigative F�€ " v v' - ''"�•` A- LC
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFlCE USE ONLY This requesf void 18 monfhs from validafion dafe prinfed in this box.
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PLEASE PRINT OR TYPE /J�..��
Request Date / / Rough-in inspection required? ❑ Yes �Jo Inspecfion Other Than Rough- - eady Now ❑ Will Call
/ �%�� �You must ca{I the inspector when ready) Date Ready:
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I, �censed contractor ❑ owner hereby request inspection of the above electrical work at:
lob Address (Sheet, Box, or Rouie No.) Ci p
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Section No. Township Name or No. � Range No. Fire No. County ^ �
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Power
Electrical Contractor (Company Name)
SrJUhFL ��eC�'lC�(.0
Mailing Address (Conhacfor or Owner Performing I
2 � � 4 wa�Gc.i�. �ove s�
Authorized igna re nhactor or Owner Perform
`�t.�c/1
E&OOOOIA-11 8/96 STATE
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Phone No�
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x License No.
1700
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COPY - SEE INSTRUCTIONS ON BACK�OF
Phone