P - 84533�'I I�11 H IlCaif.�l II III II III II III �I II) (I ��I ((�II M 2�esota StatOe B a dEof ERI`CA �INSPECTION
S U rn e r s i t y A v e., R m. S 1 2 8, S t. P a u l, M N 5 5 1 0 4
* 0 2`) 9 3 6 4 0 * Phone (612) 642-0800
ome Duplex Aat. Blda. Other: New
Commercial Industrial Farm
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
D er Ran e Elec. Heat Tem . Service
above the work covered by this requesf. Enter remarks in this space and on the
Remod
copy
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I■�!17
Colculate Inspection Fee - This Inspection Request will not be accepfed without the corred fee:
Olher Fee # Service Enirance $ae Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps , ac
Street Ltg./Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'SUSEONL TOTA
$ign/Outline Ltg. Xfmr. �✓�- ��• 5���/� rp��
Alarm/Remote Control 2 5� g rJ
$wimming Pool
1 hareb certi fhaT I ins ecied fhe eledrical insfolloTion described herein on }he dates sMted
Irrigation Boom Rough-In Dote
$pecial Inspection
I�vestigative Fee F�'O°�— L-�-- Date ��
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 M THS.
2 9 9- 3 6 4� OFFICE USE ONLY This request void IS months from volidotion date printed in this box.
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PLEASE PRINT OR NPE
Request Da � Rough-in inspedion required2 � Yes � No Inspedion Other Than Rough-In: � Ready Now � Will Call
�� � (You musT coll The inspecior when ready) Dote Ready:
I, ❑ licensed contractor owner hereby request inspection of the above electrical work at:
Job� ss � t� i, Box, r Rou�No.) City % f Zip Code
�- �c. .,r. �v2� � ��j�A l �.�� `3 0�
Sedion No. Township Name or No. Range No. Fire No. ounly „ )
Occupant � >e {�, �d /�
\ L
PowerSupplier` ^ '� /1
�V j L!
Eleclrical ConTraclur (Company Name)
2 � /'� ��ctor License No.
\�
Phone No.
0
Masfer Lic. No. (Planf Elect. Only)
Mailing Address (Contrador or er Perfortning Ins tion)
Authorized ' dor or O ne rf i Insfollafion) Phone No.
' ^ 5—� )
EB-OOOOlA-10 6/95 ATE BOARD COPY- SEE INSTRUCTIONS ON BACK OP YELLOW COPV
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