P - 82882. RE(]UEST FOR ELECTRICAL INSPECTION
:� � � v� v � 8'21 Uni eSsty A ea,rRm. S-128,'St. Paul, MN 55104 -
Phone(612)642-0800
Home Duplex Apt. Bldg. Other: New ddn
Commercial Industrial Farm Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmf. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on the back of the whi►e copy only.
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Calculofe Inspection Fee - This Inspection Request will not be accepted without ihe correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps ,Q
Sheet Ltg./Traffic 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 the elechical insfallafion described herein on fhe dates stafed
Irrigation Boo RougMn Date
Special Insp
� Final D�
Investigative Fee '
THIS INSTALLATION MAY BE ORDERED DiSCONNfCTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requesf void 1 S months from validafion date prinfed in this box.
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*06189583* aqoa
PLEASE PRINT OR TYPE
Request Date . Rou h-in ins ion r u�red? �
� g pecf' eq ' ❑ Yes No Inspection Other Than RougMln: Ready Now ❑ Will Call
(`/ou must wll ihe inspector when ready� Date Ready: B
I, �licensed contractor ❑ owner hereby request inspection of the above elechical work at:
Job Add�ess �Sheet, Box, or Roufe No.) Ciry Zip Code
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Section No. Township Name or No. Range No. Fire o. n
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Occuponf � /�� � Phon� �
U • Z� .•
Power Supplier Address �
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Eleclrical Confracfor (Company Name) Contmcfor License No. Master Lic. Mo. (Planf Elecf. Only) �
CAdi700
Mailing d ress onhacfor or ner Performing Insfallafion) �
2114 GIASHINGTON ST N.�. � l�
Aufhorized Si natu e �Conhactor o r Performing I(s� Ibr1M ,,,, Phone No.
I �� .R, f �
EB-OOOOIA- 1 S/96 STATE RD COPY - SEE INSTRUCTIQNS ON BACK OF YELLOW COPY