P - 80709� REGIUEST FOR ELECTRICAL INSPECTION ��
���o ��� � 1n821eUniversity A ea,rRm. S1e128,ISt. Paul, MN 55104 �
Phone (612) 642-0800 `'°�'
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm emod Re air
Air Cond. Htg. Equip. Water Htr. Coad 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 only.
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Calculate Inspection Fee - This Inspection Request will not be accepied 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 TOTAL�,��
$ign/Outline Ltg. Xfmr.
Alarm/Remote Conhol
$wimming Pool
I hereb certi that I ins ted the elechical insfallaKon described herein on the dates stated
Irrigation Boom Rough-In Dare
Speciallnspecti �
Final
Investigative Fee "��—
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 monfhs from validation dafe printed in fhis box.
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PLEASE PRINT OR TYPE
Request te Rough-in inspection required$ ❑ Yes o Inspecfion Ofher Than RougMn: ❑ Ready Now ill Call
� �You musf call the inspector when ready� Dafe Ready:
I, licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Addreu Sfreer, Box, r Ro No.) . Ciy Zip Code
5 � -r�,tl' I'�l.-e � �'Y� SS��Z
Secfion No. Township Name or No. RanBe No. Fire No. Cour�Y� �
Occupant
ro��
_ ZZ�S
Eleclrical Conhacfor (Company Name� Contr cense No. Masfer Lic. No. �Planf Elecf. Only)
BLAITdE FITCa. A;C ELECT., I�VG. �` Cf
Mailing Addre ation)
AN N 55?�n
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Authorized i afure �C ka r r ner PerForrti ns II , Phone No.
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EB-OOOOI A- 1 8/9�� �p� �OARO COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY