P - 80827RE(�UEST FOR ELECTRICAL INSPECTION
8`t i'� 911 � 8121 Univers � A ea,r Rm. S-12r8,'St. Paul, MN 55104
� Phone (612) 642-0800
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other: `�
Dryer Range Elec. Heat Temp. Service � �e rrBCt�L-
"X" above the work covered 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 accepted without the correct fee:
Other Pee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Sheet Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator iNSPecTOR'S USE ONLY TOTAL s
Sign/Outline Ltg. Xfmr. �0'
Alarm/Remote Control
Swimming Pool I hereb certi that I ins ted the elechical installation described herein on the dales staled
�ff19O�lOfi'800 � RougMn Dafe
Special Ins
Finol D �
Investigafive Fee -� d—
THIS INSTALLATION MAY BE ORDERED CNSC CTED IF NOT COMPLETED WITHIN 18 MO�iTHS.
—.— _—____ _ _ _�i: _ _ -- —_ __
OFFICE USE ONLY This requesf void 18 months from validation date prinfed in ihis box. '�
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PLEASE PRINT OR TYPE
Request Date Rougfrin inspecfion required? ❑ Yes No Inspecfion O�er Than RouglFln: Ready Now ❑ Wi�l Call
��+�9 �`(ou must call the inspector when ready� � Date Ready:
I, '� licensed contractor ❑ owner hereby requesf inspection of the above electrical work at:
Job Addreu (Street, Box, or �Roule No.) City Zip Code
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$ection No. Township Name or No. Range No. Fire No. Couny
�N O /�
Occu nr Phone No.
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Power Supplier Addr\ s
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Elechical Contractor (Company Name) -- Confracror License No. Masfer Lic. No. (Plant Elecf. Only)
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Mailing Address (Conhacror or Owner Performing Installafion)
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Aufhorized Signature (Conhacfor or Onwner Pedorming Insfalkfionj Phone No.
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EB4 001 A-1 1 8/96 ST BO D COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY