P - 81035f REQUEST FOR ELECTRICAL INSPECTION
J6 aJ �-� 4 5� 8'21 University A earRo�f SIe12$ ISt. Paul, MN 55104 = �
Phone (612) 642-0800 '��'
ome Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Re air
Air Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the ork covered this request. Ecterfemarks in this space and on the back of the whiie copy only.
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Calculate Inspection Fee - This Inspection Request will not be accepted without fhe correct fee:
OFher Fee # Serv�ce Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Tro�fic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
Sign/Outline Ltg. Xfmr. � ,
Alarm/Remote Control
Swimming Pool
I hereb certi that I ins ted fhe eleclrical installation described herein on the dates stated
Irrigation Boom Rough-In Da�e
Speciallnsp s`
Final D
Investigative Fee � �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFCE USE ONLY This request wid 18 months from validation date printed in fhis box.
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* 0 7 5 2 8 4 5 8* �ja 70
PLEASE PRINT OR TYPE
Requesf fe Rough-in inspecfion requiredZ ❑ Yes � No Inspecfion Ofher Than RougMn: �Ready Now �.Will Call
(You musf call the inspector when ready) Date Ready: �
I, icensed confractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sheef, Box, or Route No.) Ci1y Zip Code
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Secfion No. Township Name or No. Range No. Fire No. C �n �
Occupanf Phone No.
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Power Supplier Address
Elechiml Cor�racfor �Compan ame� Conhacfor License No. Master Lic. No. �Planf Elecf. Only)
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Maili� dress (Conhacror or Owner Perfor ing Installation� / ���
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Authorized S' re �Conhacfor or Owner Performing Insfallafion ' �� Phone No.
✓ � � �' ��� �7�
EB-0OOOIA- 1 8/96 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY