P - 80700REQUEST FOR ELECTRICAL lNSPECTION
� U e! � 911 � 8'21 Universty A earRm. 5-128,ISt. Paul, MN 55104 - �
' Phone(612)642-0800
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Re air
Air Htg. Equip. Water Hh. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on the back of the white cvpy only.
�G'tl��'IR CC � lT ��'�C P�% `!C Cd N9 e'�+ T
Calculate Inspection Fee - This Inspeciion Request will not be accepted withoui the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobiie Home Park Stall 0 to 200 Amps 0 to 100 Amps Q
Street Ltg./Troffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR�S USE ONLY TO
Sign/Outline Ltg. Xfmc /
Alarm/Remote Control a,Q ���
Swimming Pool
I hereb ceAi that I ins ted the elechicol installation described herein on 1he dates staled
irriqation Boom R�„�i,.i„ ��
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Investigative F .,� �� o
THIS INSTALLATION MAY BE ORDEREO DISCOPtNECTED IF NOT COMPLETED WITHIN 18 MOMTHS.
OFFICE USE ONLY This requesf void 18 months from validafion dafe prinfed in ihis box.
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PLEASE PRINT OR TYPE
Requesf Daie Rough-in inspection required? es No Inspection Ofher Than Rough-In: eady Now � Will Call
— 3�� (You must call ihe inspectw when ready) Dafe Ready: (� � 3
�, censed conhacror ❑ owner hereby request inspection of the above electrical work at:
Job Addreu (Sfreet, Box, or Route No.) Zip Code
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Secfion No. Township Name or No. Range No. Fire No. Cou y
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Phone No.
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Electrical Confraclor (Compa�y Name)
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Moiling Address onkacior or Owner Performinf
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Authgi��re (Conhocror or Owner P�i
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STATE BOARD
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Phone No.
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INSTRUCTIONS ON BACK OF YELLOW COPY