P - 83216,e REGIUEST FOR ELECTRICAL INSPECTION
6� 0�"4' ��+ � 8121 Univers� A ea,rRm. S 128,ISt. Paul, MN 55104 u 3
Phone (612) 642-0800 "�'
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm emod Re air
Air Cond. Htg. 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 Inspec►ion Fee - This Inspection Request will not be accepted 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 �
Sfreet Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
Sign/Outline Ltg. Xfmr. ��-�
Alarm/Remote Conhol
Swimming Pool
1 hereb certi that I ins ted the elechical installafion described herein on Ihe dafes staled
Irriqation Boom R�,,,,�.i„ pa�
Investigative Fee - "` ^' ��� � �- �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
� - — — - __ _ _ _ -- — — -----
� OFFICE USE ONLY This r uest void 18 months 6om validation date rinted in this box.
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* 0 6 5 0 4 7 8 1* �09
PLEASE PRINT OR TYPE
Requesf Dafe Rough-in inspecfion required$ ❑ Yes No Inspecfion Other Than Roughan:
6�=9� (You must call ihe inspector when ready) Date Ready: 6 �3�
I, �licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sheet, Box, or Route No.) City
6��/- .S�s7'NE Fr rQlle
Secfion No. Townshio Name w No. Ranoe No_ Fire No_ C��nw
/ya tiso
Eleclrical Conhaclor (Company Name)
/2Ts E��rR�
Mailing Address �Co�hactor or Owner Pe
�'��D —v1.�'7��
Auihorized Signafure (Conhacfor or Owm
0
Ready Now ❑ Will Call
Zip
t'fy0 F�
Phone No.
s7i � yyy
Conhacror License No.
c cDf►-oiy�
rForming Installafion)
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- SEE INSTHUCTIONS ON BACK OF YELLOW COPY