P - 84292I I6I�I�1 I I) II� II III O II) II III (I (II I) II) �I �II I II�I ME�U° a StatO B a dEof ERcCA�INSPECTION �',.:.
1821 University Ave., Rm. S-128, St. Paul, MN 55104 �� _-
* 0 2 9 9 3 5 2 5* Phone (612) 642-080 ���
ome Duplex Apt. Bidg. Other. �� � New Addn
Commercial Industrial . Farm SZ� S�%`�! .- emod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Ran e Elec. Heat Tem . Service
"X" ab th work covered b this request. r remarks in this sp e and on the back of the white copy only.
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Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Olher Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park $tall 0 to 00 Amps 0 to 100 Amps
$treet Ltg./Troffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'susEON�Y TOTAL
Sign/Outline Ltg. Xfmr. ,S�
Alarm/Remote Control
$wimming Pool
I hereb certi that I ins eded ihe elecfrica ia tallation described herein on ihe dates stafed
Irrigation Boo Rough-In pate
Special Inspe ' ` f �"'�-"` 'Z ��
Investigative Fee Final pa •��3 ��
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
2 9 9- 3 5 2 OFFICE USE ONLY This request void 18 months from validation dafe printed in ihis box.
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PLEASE PRINT OR TYPE /�°�� �'2��
Request Date Rough-in inspeciion required2 es � No Inspecfion Ofher Than Rough-In: � Ready Now Will Call
l��_� -�� (You must coll }he inspedor whe ready) Date Ready:
I, ❑ licensed contractor �owner hereby request inspecfion of the above electrical work at:
Job Addr ss (Streef, Box, or R ute No.) City ,�' Zip C-ode-, /.
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Sedion No.
Occupant
Power Supplier
Eledrical Conir
Mailing Addres
Name or No. Range No. Fire No.
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/'2 ! ' C,� !� .S
!
� ., Addrezs ,(� � �
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mp ny Name) Contrador License No.
i
�for or Owner Performing Installafion)
County
Phone No.
��`�-
Authorized Signature (Contrador or Owner P rm' g stallafion)
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� � �� L� e,
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EB-OOOOlA-10 6/95 STATE BOARD COPY- SEE INSTRUCTIONSON BACKOF YELLOW COP�
ivale -
'l1l.Sl��
Masfer Lic. No. (Plant Elect. Only)
Phone No.