P - 83213REQUEST FOR ELECTRICAL INSPECTION -
�`t ��� V� � 8121eUniversty Ave.rRm. S-128,ISt. 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. $ervice
"X" above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
Calculate Inspection Fee - This Inspection Request will not be accepted without ihe correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stail 0 to 200 Amps 0 to 100 Amps
Sheet Ltg./Traffic Sig. Above 200 Amos Above 100 Amps
Transformer/Generator INSPECTOR'S use oN�v TOTAL
Sign/Oudine Lig. Xfmr. f� H-►'ti.-� L� ���
�L,� �. �
Alarm/Remote Confrol
Swimming Pool
I hereb certi that I ins cted the elechical installafion described herein on the doles stated
Irrioation Boom r.. _ o,.,,..ki„ aM. ��
� Investigative Fee � � //'---� � J`/ �� �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validafio� daM printed in this box.
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* 0 6 4 5 6$ 2 6� ���
PLEASE PRINT OR TYPE
Requesf Date Rougffin inspecfion required2 ❑ No Inspecfion Other Than RougMn: ❑ Ready N Will Call
�, � 8 (You must call the inspector when ready� Date Ready:
I, �licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address Sheet, Box, or Route No.� Ciy Zip Code
�� D ,�� � v�tR � Dz.�
Section No. Township Name or No. Range No. Fire No. Couny
Occupant � l�
7��
Power Suoulier
Controcior
Phone No.
Contracror License No. I Master Lic. No.
Mailing Addreu (C n acfor or Owner Performing InsfallaNsn)
� R �- �� • 3"��� �.
Authorized Si atur onhacror or Owner P rmmg tallofion) � O� Phone �o. �
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E&00001 A-1 / 6 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY