P - 84529REf�UEST FOR ELECTRICAL INSPffCTION _
` I�II�� I� I�) �I III II III (I (II II II) II III (� �II I(III 8'21 Un VI erstat AvearRmf S-1281cSt. Paul MN 55104 /u ':: `
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��� 5 1 3 6 L * �hone (612) 642-0800 ��•
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod e air
Air Cond. Htg. Equip. Water Hir. Load Mgmt. Other:
D er Ran e Elec. Heat Tem . Service
"X" above the work covered by this request. Enter remarks in fhis space and on the back of the whita copy only.
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Calculate Inspection Fee - This Inspection Request will not be accepted withouf the correct fee:
Olher Fee # Service E�trance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall to 00 Amps 0 to 100 Amps
$treet Ltg./Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'SUSEO��, ,'Y� TOTAL
$ign/Outline Ltg. Xfmr. /fi�..f� G �`-x' �'� �5.s�
Alarm/Remote Control n:>i �'3 � j� "`4 �
$wimming Pool
I hereb ceAi that I ins ecfed the eleckical insiallation described herein on fhe daMs sMted
Irrigation Boom Rough-In pa�
Special Insp
Final
Investigative e w =C - — - � �-<� --- 7
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 16 MONTHS.
�2 9 5-13 6� OFflCE USE ONLY This request void 18 monlhs from validation daM prinfed in this box.
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PLEASE PRINT OR TYPE ��� ' � ! ���
Request Date Rough-in inspedion required2 � Yes No Inspedion Other Than Rough-In: Ready Now � Will Call
�`� (� /+ (You musf call ihe inspecior when ready) Date Ready: y,`, �,� ^[�
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I� licensed contractor ❑ owner hereby request inspection of the above electrical work at:
1ob Address (Sfreet, Box, or Route No City Zip Gode
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Secfion No. Township Name or No. Range No. Fire No. Co ^
Occupant
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Powe�
No.
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Elechical Controctor (Company Name) ConiracTor License No. Moster lic. No. (PIanT Eled. Or
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Mailing Add ss (Confrador or Owner Perfortni InsMllotion)
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A� ori Si re nfrador or Owner Perfortning Installation) Phone No.
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EB-OOOOlA-10 6 5 STATEBOARDCOPY- SONBACKOFYELLOWCOPY