P - 80842RE(�UEST FOR ELECTRICAL INSPECTION
,.1 �� 3 3 3� 8'21 University A ear Rm. 8e128, ISt. Paul, MN 55104 -
Phone(612)642-0800
ome Duplex Apt. Bld�. Other: New n
Commercial Industrial Farm Remod 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 thi space and on the back of the white copy only.
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Calculate Inspection Fee - This Inspection Request will nOt be accepted withou► 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 oN�r TOTAL
Sign/Oudine 1tg. Xfmr.
Alarm/Remote Confrol aO SQ
Swimming Pool
I hereb certi that I ins the eleclrical installafion described herein on the dates srofed
Irrigation Boom RougMn Date
Speciallns ' '
Final Da
Investigative �e ` � ' �'
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
. OFFICE USE ONLY This request void 18 months from validation date printed in fhis box.
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PLEASE PRINT OR TYPE �%
Request Dqfe �� n�y Rough,in inspecfion required8 ❑ Yes o Inspection Other Than Rough-In: Ready Now ❑ Will Call
�J� �; (You musf call the inspecfor when ready) Date Ready:
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Addreu ($heef, Box, or Route No.) City � Zip Code �
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Section No. Township Name or No. Range No. Fire No. Couny �
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Occu nt Phone No.
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Power $upplier Address > � I ,
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Elechical Conhacfor (Company Name� � Conhatlor License No. Masfer Lic. No. (Plant Elect Only�
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Mailing Address (Conhacror or Owner Performing Insttillafion� ,��/'
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Authorized Signafur (Conh r or Owner Performirg Insiallafion� Phone No.
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EBOOOOIA-i 1/96 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY