P - 84456I I�����jl II II� II (II II �II O III II III I) III I IIII M 2n�Uota SsatOe BQ dEof ERI`CA �INSPECTION �,����
�� �� � ty A ., Rm. S 12i, St. �aul, MN 55104
* 0 3 4 2 6 3 9 2* 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:
D er Ran e Elec. Heat Tem . Service
"X" above the work covered by fhis request. Enter remarks in this space and on the back of the white copy only.
Calculate Inspection Fee - This Inspection Requesf will not be accepted without the correct fee:
OFher Fee # Service Enirance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'SUSEONLY / TOTAL
Sign/Outline Ltg. Xfmr. ���,,,,p-�— �y�,°M� � �.
Alarm/Remote Control �
Swimming Pool `
I hereb certi fhaT I ins eded the elecfrical instoll 'on described herein on fhe doMS stafed
Irrigation Boo Rough-In pate
Investigative Fee -`' "'�' "° .- 2 Z—Q�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
�°'T �— 6 3 9[� OFFICE USE ON This request void 18 months from validafio� date printed in }his box.
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PLEASE PRINT OR TYPE `
� Request Date Rough-in inspedion requiredZ ❑ Yes � No Inspeciion Ofher Than Rough-In: � Ready Now � Will Call
/c �-�` �� (You must call the inspedor when ready) Date Ready:
I, ❑ licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sfree}, Box, or Route (Jo.� �\ City �� Zip Co�
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$ecfion No. Township Name No. Range No. Fire No. Counly
�C� � _ J�-�O di
Occupanf , ` Phone No.
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Power $upp ierw . _ Addrae�-:`1 � 1
��:�L...S �V`�,�_ r� �J 6�1 ��s l ��`
� Conhador license No. Master Lic. No. (PIaM Eled. Only)
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Authoriz Signature(C Owner erfo ing stallofion) �� Pho���'C��
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