P - 83312. RE(IUEST FOR ELECTRICAL INSPECTION
/� v����' O � 8121 University A ea,rRm. S-128,'St. Paul, MN 55104 =
Phone (612) 642-0800 '�'
Home Duplex Apt. Bldg. Other: � New Addn
Commercial Industrial Farm �L'�'� �� �"� Remod Re air
ir Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this reqvest. Enter remarks in this space and on the back of the white copy only.
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Calculate Inspection Fee - This Inspecfion Request will not be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONIY TOTA �
Sign/Oudine Ltg. Xfmr.
Alarm/Remote Conhol
Swimming Pool
I hereb certi Ihat I ins fhe elechical installation dexribed herein on the dates stafed
Irrigation Boom RouaMn Dare
THIS INSTALLATION MAY BE ORDERED DI3CONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 monfhs from validation dafe printed in this box.
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* 0 6 8 5 1 9 0 1* l�-3�j
PLEASE PRINT OR TYPE
Requesf Date Rough-in inspeclion required$ ❑ Yes Inspecfion Other Than Rough-In: eady Now ❑ Will Call �.
�Vou must call the inspec�or when ready) Date Ready:
I, � i ensed conhactor ❑ owner hereby request inspection of the above elechical work at:
Job re �Sh x, w Rou No.) � Cily Zip Cpde�, J���
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Secfion No. Township Name or No. � � � Range No. Fire No:
Occupa � /� �
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Power Suppli r A ress
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Elechicyl Conhactor (Company Name1 •, i? Conhactor Li
Phone
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Mas�er Lic. No.
or Vwner rertorming InsfallatlonJ ��
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kto�Owner Performing Installafion) � �y � Phone No. ��
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STATE BOARD COPY - SEE INSTRUCTONS ON BACK OF YELLOW COPY