P - 83399REQUEST FOR ELECTRICAL INSPECTION
�� e���� � in821 Uni essity A ea,rRm. Se128,ISt. Paul, MN 55104
Phone(612)642-0800
Home Duplex Apt. Bldg. Other: New Addn
ommercial Industrial Farm emod Re air
ir Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
ryer Range Elec. Heat Temp. Service
"X" above the w rk overed 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 accepied withoui ihe correct fee:
Other Fee # Service Entrance Si e Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to ps 0 to 100 Amps
Sfreet Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Trpflsfprmer/Generator iNSaeCrOa'S USE ONLY . TA �
$ign/Oudineltg. Xfmr.
..
Alarm/Remote Confrol
Swimming Pool
I here certi that I ins the eleclrical insfallafion described herein on the dafes sfafed
Irrigation Boom RougMn Dare
Special Insp i �" '
- Final p �y
Investigative ee �>
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 8 MONTHS.
OFFICE USE ONLY This request void 18 monfhs (rom validation dafe printed in this box.
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PLEASE PRINT OR TYPE
Requesf Date � Rough-in inspecfion required? es ❑ No Inspacfion Ofher Than RougMn: eady
❑ R Now � Will Call
,�- � �You must mll the inspecfor w en ready� Date Ready:
I, icensed confractor ❑ owner hereby request inspection of the above electrical work at:
Job Addreu �Sheet, Box, or Route No. City Zip Code
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Section No. Township Name or No. Range No. Fire No. Co ry
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Power Suoolier AddrQSS �
ical Conhocror (Company Name) Conhador License No. Master Lic. No. (Planf Elecl. OnFy)
rL�. �. �(� � 6 2�15 (� �''1
ng Address (Conkacior or Owner Performing Installafion)
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>rized gnature �Conh or ner r Installafion� � � � Pho e No.
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1 A-11 8/96 STATE B COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY