P - 84618\
I�I�III IIIII IIIII IIIII IIIII IIIII IIII) IIIII IIIII MEn�esota StatOe B a dEofTE�R�A�INSPECTION ;;'.;:...
1821 Urnversdy Ave., Rm. S 128, St. Paul, MN 55104
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Home Duplex Ap1. Bldg. Other: (- ! New Addn
Commercial Industrial Farm �� �_� � Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
D er Ran e Elec. Heat Tem . Service
"k' 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 the correct fee:
Olher Fee � $ervice EMrance Size Fee # Circvits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Sireet Ltg./Traffic $ig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR's usE O Y � /�° TOTAL
Sign/Outline Ltg. Xfmr. G.�� ��t ` �/��� C� s'��
Alarm/Remote Control
$wimming Pool
I hereb certi that I ins ecfed the eledri al installation described herein on the daMs stated
Irrigation Boom Rough•In Da ? � /
Special Insp , '
Final ,q� >
Investigative Fee � c-�--� �-pc-d
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETF�WITHIN 18 MONTHS.
2 9 9- 3 7 4:� OFFICE USE ONLY This request void 18 months from validation date printed in this box.
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PLEASE PRINT OR TYPE "
Request Daie � Rough-in inspection required2 Yes � No Inspeclion Olher Than Rough-In: � Ready Now Will Call
'� /�`" (You must call the inspedor n r dy) Daie Ready:
I, ❑ licensed contractor�owner hereby request inspection of the above elecFrical work at:
Job Address (Slreet, Box, or Route No. City Zip Code
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Secfion No. Township Name o o. Range No. Fire No. ou ry
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Occupant _ l�� /� /�� r P oneN�� '-����
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Power Supplier Address .
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Elechical Conha (Company N me) Conhador License No. Master Lic. No. (Plant Elecf. Only)
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Mailing Address (Con r or Owner Performing Inswllafion)
Authorized Signature ( r or Owner tallafion) Phone No.
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EB-00001 A- 0 6/ 5 STATE 80ARD COPY - SEE INSTRU�TIONS ON BACK OF YELLOW COPY
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