P - 81659REQUEST FOR ELECTRICAL INSPECTION
8; V�� 2 4 4� 8'21 University Ave.,rRm. S-128,ISt. Paul, MN 55104
Phone (612) 642-0800 �1`
Home Duplex Apt. Bldg. Other: �New Addn
Commercial Industrial Farm �i�i�7� �1�'!�l Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by ►his request. Enter remarks in this space and on the back of the w iie cRRy only.
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Calculate Inspeciion Fee - This Inspection Request will not be accepted without the correci 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 ONL/r� � T �
Sign/Outline Ltg. Xfmr. ���
Alarm/Rem n I ;� !� � ��(, �,c/a�'
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Swimming I
I hereb certi that I ins the electrical installation described herein on the'dates sfated
Irrigation Boom Ro„9�„ pa
$pecial Inspection '� � '— U
Investigative Fee F��I r
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THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months 6om validation dofe printed in this box.
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PLEASE PRINT OR TYPE
Requesf Dafe Rou ifin ins ion r uired$ Yes
/ g pecY eq ❑ No Inspection Other Than RougMn: ❑ Ready Now Will Call
.. � � � (You must call the inspecror when ready) Date Ready:
I, icensed contracror ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sheet, Box, or Roufe No.) City Zip Code
7.sor �ic,� � �t�GP 3
Section No. Township Name-or No. Range No. Fire No. County
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Occupanf ^,� Phone No.
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Power Supplier � (� / ( Address
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Electriwl Conhacror (Company Name� , Confraclor License No. Nlaster lic. No. (Planf Eleci. Only)
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Mailing Address (Conhactor or Owner PerForming Installafio �
y �i/,�� �//s ,v�e. {�"9��9� �l^/- s"��/
Autho' ed Si fra r Own Pe rming Installafion� Phone No.
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EB-0OOOIA- 1 8/96 �� B ARD COPY - SEE INSTRUCTIONS ON BACK OF YELLO p�� '�90� %� p