P - 84124REGIUEST FOR ELECTRICAL INSPFCTION
5`t ��° 8 5 5� 1n821eUniversaty A earRm. S-128,ISt. Paul, M�N_ 55104
, Phone (612) 642-0800 "°�'
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod e air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Terr�p. Service
"X" above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
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Calculate Inspection Fee - This Inspection Request will not be accepted without the correc! fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps � 6 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL �
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Alarm/Remote Control
Swimming Pool
Irriaation Boom
that I inspected the electrical insmllation described herein on the dafes stafed
Investigative �ee" ``'' �"✓ � *'`` � �L �
THIS INSTALLATION MAY BE ORDERED DISCO TED IF NOT COMPLETED WITHIN 8 MONTHS.
OFFICE USE ONLY This requesf void 18 monfhs from validation date prinfed in this box.
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7k 0 5 4 9 8 5 5 5 7K PLEASE PRINT OR TYPE �:5 .,`��
Request Dafe Rough-in inspection required? ❑ Yes No Inspection Other Than Rough-In: Recdy Now ❑ Will Call
!� �'�� �' � (You musf call 1he inspector when ready Date Ready: `� ���
I, licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.� City � Zip Code
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Section No. Towr,ship Name or No. Range No. Fire No. Coulty �
Occupanf
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Power Supplier
Elec ical Contractor (Company Name)
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Mailing Addres (Confractor or Owner PerForming
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(Conhocror or Owner
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Phone No.
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Conhoctor License No. I Master Lic. No. �Plant Elect. O
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- E INSTRUCTIONS ON BACK OF�YELLOW COPY