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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. $ervice "X" above the work covered by this request. Enter remarks in this space and on the back of the white copy only. Calculate Inspection Fee - This Inspection Request will not be accepted without ihe correct fee: Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee Mobile Home Park Stail 0 to 200 Amps 0 to 100 Amps Sheet Ltg./Traffic Sig. Above 200 Amos Above 100 Amps Transformer/Generator INSPECTOR'S use oN�v TOTAL Sign/Oudine Lig. Xfmr. f� H-►'ti.-� L� ��� �L,� �. � Alarm/Remote Confrol Swimming Pool I hereb certi that I ins cted the elechical installafion described herein on the doles stated Irrioation Boom r.. _ o,.,,..ki„ aM. �� � Investigative Fee � � //'---� � J`/ �� � THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS. OFFICE USE ONLY This request void 18 months from validafio� daM printed in this box. i��iiiiliiiiliiiiiii�iiiiiiiiii�iiii� •� �'� * 0 6 4 5 6$ 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. � Q E&00001 A-1 / 6 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY