P - 80118REQUEST FOFE ELECTRICAL INSPECTION
V O�- 3 5 8[�l 8121 Univers ty Ave. r Rm. S-128,'St. Paul, MN 55104
Phone (612) 642-0800 �� �
Home Duplex Apt. Bldg. OFher: New Addn
Commercial Industrial Farm Remod Re air
Air Cond. Fitg. Equip. Water Htr. toad Mgmt. O r:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on t e back of the white copy only.
Calculate Inspection Fee - This Inspection Request will not be accepted withouf the correct Fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park I 0 to 200 Amps 0 to 100 Amps
Sheet Ltg./Tr Above 200 Am s Above 100 Amps
Transformer/ enerator INSPECTOR�S USE ONLY T� ���
Sign/Outline Ltg. X�rnr. �
Alarm/Remote Control
Swimming Pool
I hereb certi that 1 in ted e elechirnl installation deuribed herein on 16e dates staied
Irrigation Boom Roo9Mn � � �2
Special Inspection
firwl p iQ2
Investigative Fee � �
THIS INSTALLATION MAY BE ORDERED DISCONN ED IF NOT COMPLETED WITHIN 18 MONTHS_ .
OFFlCE USE ONLY This request wid�months from wlidotion date prinied in this box.
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PLEASE PRINT OR TYPE
Requesf Date Rough-in inspection required? ❑ Yes ❑ No Inspeclion Other Than RougMn: ❑ Ready Now � Will Call
(You musf call the inspecfor when ready) Date Ready:
I, ❑ licensed conhactor �owner hereby request inspection of the above electricol work at:
lob Address (Sfreet, Box, or.Route No.) n �� ��� Ci y Zip Code
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Section No. Townshio Name w No. Range No. � Fire No. Counly �
Phone No.
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wer auppi�er ` ....��»
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:cMica�Conk� ompany Name) Conhactor License No. Masfer lic. No. �Plant EIecT. On
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�iling Address (ConhacPor er Performing Installafion)
.�a .� � ���� �'�
ithorized SignaNre (Conkactor o ner PerForming Insfallation) Phone No.
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)0001A-11 8/96 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY