P - 84280REQUEST FOR ELECTRICAL INSPECTION ��'F�"k�, EB-00001-09'
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See instructions for completing this form on back of yellow copy. �� 3
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, O O "X" Below Work Covered by This Request `�y »�
New Add Rep. Type of Building Appliances Wired Equipment Wired
Home Range Temporary Service
Duplex Water Heater Electric Heating
Apt. Building Dryer Load Management
Comm./Industrial Furnace Other (Specify)
Farm Air Conditioner
Other (specify) Contractor's Remarks j __ . �� /1_ � � ������
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Compute Inspection Fee Below: ��� ����T ��T
# Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Swimming Pool 0 to 200 Amps 0 to 100 Amps
Transformers Above 200 Amps Above 100 Amps
Signs i�spectors use oniy: TOTAL
Irrigation Booms ,,7j�= � �
Special Inspection
Alarm/Commu ti - THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT
Other Fee �� %.� COMPLETED WITHIN 18 MONTHS.
I, the Electrical Inspector, hereby Rough-in Date I
certify that the above inspection has Final �� r� p y
been made. �z.'_"_"'- �-:e L,�� �J
OFFICE USE ONLY
This request void 18 months from
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Request Date Fire No. Rough-In Inspection Required Inspec ion Other Than Rough-In
` p� (YOU must call inspector when ready) � Ready Now � Will Notify Inspector
� / � / � � � Yes ❑ No Date Ready
I�1�licensed contractor ❑ owner hereby request inspection of above electrical work at:
Job Address (SVeet. Box or Route No.) � Ciry ,
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Section No. Townsh�ame or No. Range No. County
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Occupant(PRINT) Phone No.
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Power Supplier Address
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Electricai Contractor (Company Name) Contractor's License No.
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Mailing Address (Contractor or Owner Making Installation)
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Authorized Signature (Contractor/Owner Making Installation) Phone Number
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Gr ggs MidwayTB dg B Room SF128ECTRICITY I II� � � �I III II�II BNL SSEPROPI ER INSPECTONF EE pT
� 1821 University Ave., St. Paul, MN 55104 —
Phone (612) 642-0800 ENCLOSED.