P - 83865I IINl� I��I�I�� II I�I II II) I) III (I III II I�I I� II� � II�I gEQU E eSsaOAve., Rm� S-�1c SASt.I Paul�, M�N 55 04
� 0 2 9 9 1 9 8 2* Phone (612) 642-0800
�( Home Duplex Apt. Bldg. Other: �dew
Commercial Industrial Farm Remo�
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Tem . Service
"X" above the work covered by this request. Enter remarks in this space and on the back of the white copy
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Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Olher Fee # $ervice Enhance Size Fee # Circuifs/Feeders
Mobile Home Park Stall 0 to 200 Amps 3 0 to 100 Amps
Street Ltg./Traffic $ig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'SUSEONLY TOTAL
Sign/Outline Lig. Xfmr. �
Alarm/Remote Control
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Fee
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Swimming Pool /�I� ��'la"'�!7
1 hereb cerfi that I ins eded ihe eledrical installation described �ein on ihe dates stated
Irrigation Boom Rough-In �-°-_" �'/� �_.____._____ °at j.�_3- j^ J
Special (nspect' ♦_
' Final � �at�
Investigative F G �` —
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
2 9 9-19 g OFFICE USE ONLY This request void 1 S monihs from validation date printed in }his boz.
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PLEASE PRINT OR TYPE `� �
Request Date Rough-in inspecfion requiredZ � Yes ❑ No Inspedion Other Than Rough-In: 0 Ready Now � Will Call
(You must mll ihe inspedor when ready) Date Ready:
I,'� licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address Sireef, Box, or Roufe No.) City �— Zip Code
/ �(�o �1- ST, 11�E, �-2/ �I� y
Secfion No. Township Name or No. Range No. Fire No. County
Occupant
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Power $upplier /� S � Addrees
Elecirical Contrador (Company Name)
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Mailing Address (Con}rador or Owner Performing Installation)
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Auths«eed-S�,qnature (Con}rador or O�erfo1ming Installofion) �
EB-OOOOlA-10 6/95
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No.
7PS � 23Z�
Master Lic. No. (Plont Eled. Only)
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� �;3 Phone No.
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BOARD C'OPY - SEE INSTRUCTIONS ON BACK OP YELLOW COPY