P - 84455�I'���I �I) (I IIi II III II I�I I) III II III I) III I IIII 'RE(.lUota Stat�e B a dEo ERI`CA �INSPECTION ����F
I M
N 1821 University Ave., Rm. S-128, St. Paul, MN 55104
* 0 3 4 2 6 3 8 4� Pnone (s� 2) sa2-osoo �� �
Home Duplex Apt. Bldg. Other: New Addn
ommercial Indushial Farm Remod Re air
Air Cond. Htg. Equip. Water Htr. Lood Mgmt. Other:
D er Ran e 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 only.
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Olher Fee � Service Enirance Size Fee Circuits/Feeders Fee
Mobile Home Park Stall 0 to 00 Amps � to 100 Amps
Street Ltg./Traffic $ig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'SUSEONLY j� TOTA�
Sign/Outline Ltg. Xfmr. �t ��Q�q�e �%�-a�
Alarm/Remote Control '�` �'�'�' '�'�`�
Swimming Pool
I hereb ceAi }hat I ins ed the eledrical insfallation described herein on 1he dates stated
Irrigdtion Boom Rough-In pat c�
Speciallnspe � � '-Z-? G�'
Final �" ry, e� ^�
Investigative Fee � T `l l
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
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3 4 2- 6 3 8� OFFICE USE ONLY This request void 18 months from validation date printed in this box.
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PLEASE PRINT OR TYPE ���
Request Date Rough-in inspection required2 Yes � No Inspection Other Thon Rough-In: Q Ready Now Will Call
(You musf call fhe inspedor wh rea y) Date Ready:
I, ❑ IicEn ed� ra owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.� � � l City {� � Zip Co�
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$edion No. Towns ip Name No. Range No. Fire No. Cou tv .a�
.a
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Occupant
�j�iCli,� �U' 1 -QY�
Phone No.
Power Supplier' L/ � Addres�;' �
' � � �S l Ct ! (% C1
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Elechiwl oniracfo Gomp y Name) Confrador License No. Master Lic. No. (Plant Eled. Only)
�C 23
Mailing Address (Confrador or Ow er Perf�ming Installa'on) �?� �
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Authorized Signature ( o tm or r Perfo i Instollafion) � '� '/ /] Phone No. /
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