P - 83327_��`�- REf�UEST FOR ELECTRICAL INSPECTION
���� �� v tl ��� � ing21 Unversty A earRm. S1e128,ISt. Paul, MN 55104
, Phone (612) 642-0800
Home Duplex Apt. Bldg. Other: New
Commercial Industrial Farm Remod
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 ihe bock of the white copy
Calcvlate Inspection Fee - This Inspection Request will not be accepted withou► the correct fee:
Other Fee # Service Entrance Size F # Circuits
Mobile Home Park Stali 0 to 200 Amps 0 ro 100 A
Street Ltg./Traffic Sizj: Above 200 Am s Above 104
TransFormer/Generator INSPECTOR'S USE ONLY
ine ltg. Xfmr.
note Control
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Swimming Pool
I hereb certi that I ins the elechical insfallation dexribed herein on fhe dates sfated
Irrigation Boom Ra„9�,.i„ ��. pare ,j�
Specia� Insp t `�'`� `� ? - S`
Firwl �
Investigative Fee o `�'—Z�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFlCE USE OMLY This requesf void 18 monlhs from validafion date printed in this box.
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* � 5 7 � 7 4 8 4* PLEASE PRINT OR TYPE
Request Date Rough-in inspection required$ ❑ Yes ❑ No Inspeclio� Olher Than RagMn: Reody Now 0 Will Call
�_. Q� � �You must call the inspector when ready� Date Ready:
1, licensed contractor� awrrer hereby request inspection of the above elech�ical work at:
7ob Address (Sheet, Box, or Route No.) Ciy Z�C� l�
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Section No. Township Name or No. Ranqe No. Fire No. C nH � �
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�I Confracfor �Company Name)
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Address (C cfor o� Owner Performing Install
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red Sipnalure IConhactor or OvIRc Performirg li
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-�Conhadw License No. Master Lic. No. (Planf Elecf. Only)
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BOARD COPY - SEE
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�ON�BACK OF YELLOW COPY