P - 81030RE(�UEST FOR ELECTRICAL INSPECTION
8��� O 0� � 8121eUniversity A earRm. S-128,'St. Paul, MN 55104
� Phone (612) 642-0800 '�'
ome Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Re air
Air Cond. Hfg. 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 only.
Calculate Inspection Fee - This Inspection Request will not be accepted without fhe correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
► Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
$treet Lig./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
Sign/Outline Ltg. Xfmr. I���
Alarm/Remote Conhol
Swimming Poo)
I hereb cerfi thot I ins the electrical installation described herein on the dates smted
Irrigation Boom Rougl�ln Date
Special Ins t t , �'
Investigativ Final �.�_ Da�e _ �_�j�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETEO WITHIN 1$ �NTH�.__ _
. OFFICE USE ON�Y This request void 18 monlhs from validation date printed in this box.
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* D 8 3 8 0 0 6 5* �,37v
PLEASE PRINT OR TYPE
Reqvesf Dafe Rough-in inspection required$ ❑ Yes No Inspecfion Other Than RougMn: Ready Now ❑ Will Call
�Q ��i� (You must coll the inspedor when ready) Dare Ready: �Q �G ��
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address �Sheet, Box, or Route No.) Ciy � Zip Code
'�SY9 - 5/t� „SrNE �+-r a�� �.
Section No. Township Name or No. Range No. Fire No. Counly
�Kp�
Occupant Phone No.
/4�vine s'�� �a K en 78� -6757
Power Supplier � Address
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Elechical Conhador (Company Name� Conhactor License No. Masfer Lic. No. �Planf Elecf. Only�
/�'T's EGFcT�?-/ C C! r4 0/y8'9
Mailing Address (Confracfo� or Owner PerForming InstallaTion�
8'l� -�s°7�Ava>YcJ Z �� r. .1SS39d�`
Authorized Si�hactor or Owner Performing Insfallafion� Phone No.
, Gi�--Yy� .Zv
E OlA-1 1 8/96 ST B D COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY