P - 83293RE(�UEST FOR ELECTRICAL INSPECTION
6 6°='-F �� � 8'21 Univers ry Ave.,r Rm. S-128, ISt. Paul, MN 55104
r Phone (612) 642-0800 '��
Home Duplex Apt. Bldg. Other. New Addn
Commercial Industrial Farm Remod Re air
Air Cond. Htg. Equip. Water Hh. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this requesi. Enier remarks in this space and on ihe back of the whiie copy only.
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Calculaie Inspecfion Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # Service Entranc Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 00 Amps 0 to 100 Amps --
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL�
Sign/Outline Ltg. X(mr. .7 /
Alarm/Remote Conhol
Swimming Pool
I hereb certi that I ins ected the elechical insmllation described herein on the dates sMted
Irrigation Boom RougMn Date
Specia! Ins `
Find
Investigative - —
THIS INSTALLATION MAY BE ORDERED DISC NECTED IF NOT COMPLETED WITHI 18 MO THS.
OFF7CE USE ONLY This requesf void 18 monihs from validafion date prinfed in 11iis box.
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0 6 6 9 4 3 2?� �
PLEASE PRINT OR TYPE
Request Dafe Rough-in inspeclion requiredZ ❑ Yes o Inspecfion Other Than Rough-In: ❑ Ready Now�cr Will Call
/ �You must call 1he inspector when ready) Date Ready: ��
I, (�icensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Skeet, Box, or Route No. Ciiy Zip Code
S '7 � �'V� /y'/E, ��i /ii�
Secfion No. Township Name or No. Range No. Fire No. uny
Occupanf � Phone No.
/�G �/ � �w �?4�^ O �,.�
Power Supplier Address
Elechical Conhactor (Compuny Nume� Conhacfor License No. � Master lic. No. (Plant Elecf. Only�
�'c�i �L�K /� U
Mailing Address (Conhacror or Owner Performing Installalion)
6 �� _ ,�1�3 ,� S"�5��
Aut zed Signature �Controcror or ner Performing Installation `/� Phone No.
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OlA-11 /96 STATE BOARD COPY - SEE INSTAUCTIONS ON BACK OF YELLOW COPY