P - 82707��/7 ���G� REQUEST FOR ELECTRICAL INSPECTION �-°...�, Ea-0000i-os
Y r- �, l � See instructions for completing this form on back of yellow copy.
. :
"X" Below Work Covered by This Request '� --:
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: �
Compute Inspection Fee Below:
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# Other Fee # Service Entrance 'ze Fee # Circuits/Feeders Fee
Swimming Pool / 0 to 00 Amps 0 to 100 Amps
Transformers Above 200 Amps Above 100 Am s
SI 11S Inspecror's� TOTAL
Irrigation Booms �� < �
Special Inspection
Alarm/Communication THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT
Other Fee COMPLETED WITHIN 18 MONTHS.
I, the Electrical Inspector, hereby Rough-in Date
certify that the above inspection has Final Date � ��
been made. �o
OFFICE USE ONLY �� ���
This request void 18 months from
0-18 7- 3`,� ��"� ��% 7v� 5'O
Re uest Date Fire No, Rough-In Inspection Required � I tion Other Than Rough-In
��� (You must call inspector en ready) � Ready Now �Will Notity Inspector
❑ Yes No Date Read
I�licensed contractor ❑owner hereby request inspection of above electrical work at:
Job Ad ress (Street, Box or Route No.) City
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Section No. Township Name or No. Range No. � County� /
(PRINT)
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,P�Address �
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Contracror (Company Na e)
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idress (Contractor or Owner M ing Installation} �
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' nature ��l6UOwn aking Installation) � �
�riggs-MidwayTBdg.BRoomS�28ECTRICITY jl�Il+�l+l�ll�l���l�llt�
Phone (612) 6 2-0500 St. Paul, MN 55Y04 I I� I
No.
License No.
� Phone Number /
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I���I����I UN �SSED�OPER NSP CTIONFEE ST