P - 83748REQUEST FOR ELECTRICAL INSPECTION
4 J 43 �� 5 3� 8'21 Uni essty A earRm. SI 128,ISt. Paul, MN 55104 �'
Phone (612) 642-0800 '� �
Home Duplex Apt. Bldg. Other. ew Addn
Commercial Industrial Farm Remod Re air
' ir Cond. Htg. Equi . Water Htr. Load Mgmt. Other:
Drye Rang / Elec. Heat Temp. Service
"X" above the work covere y this request. Enter remarks in this space and on the back of the white copy only.
Calculate Inspection Fee - This Inspection Request will noi be accc
Other Fee # Service Entrance Size
Mobile Home Park Stall 0 to 200 Amps
Street Ltg./Traffic Sig. Above 200 Amp
Transformer/Generator INSPECTOR'S USE ONLY
Sign/Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
without the correct fee:
Fee # Circuits/Feeders
0 to 100 Amps
Above 100 Ar
TOT�
Fee
I hereb certi that I ins ected the elechical installation described herein on the dates stated
Irri9ation Boom Rough-In Dare ��_p
Speciallnspec n + l
Final Date C`�"/
Investigative Fee -.�O — �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 monfhs from validafion dafe printed in fhis box.
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I IIII II III II �II II III �I I l�ll III II III II III I IIII ��%�
* 0 4 9 8 9 5 3 9* G�
PLEASE PRINT OR TYPE
Requesf Date Rou h-in ins ection re uired? es pec g ❑ Ready Now Will Call
g p q ❑ No Ins tion Ofher Than Rou h-In:
$" (You must call the inspecfor when ready) Date Ready:
I, icensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sfreet, ox, or Roufe No.� � Zip Code
C�- �a e
Section No. Township Name or No. Range No. Fire No. Co y _,
� S� �
Elechical Conimcfor �Company Name)
CITtES �LECTRIC, INC.
�
Mailing Address �Con}ractor or Owner Performing In ti 10
� �
Authorized Siqnature n�•or or P �nll�n��
STATE BOARD COPY
Phone No.
License No. Master Lic.
7.
_ , �� Phone No.