P - 83882' I I�I il ��I (I II� II III II (I) II �Ifl II III II III II ��I I IIII $E�U Ea SSaO Be dR o SR c 8 St.l Paul,�4 �� ��3�
.� 0 2 9 9 4 1 5 0* Phone (612) 642-0800 �`"�'°�
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Home Duplex Apt. Bldg. Other• ', �'_ ;�� `�.�?,' New • Addn
�ommercial Industrial Farm �`� �.� J Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Ran e Elec. Heat Tem . Service
"X" above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Olher Fee # Service Entrance Size Fee # Circuils/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps ��, C�
Street Ltg./Traffic Sig. Above 200 Amps Above 100�?QAmps 1�, E�
Transformer/Generator INSPECTOR�SUSEON/LY TOTAL
Sign/OutlineLtg.Xfmr. �� %,.�c� — ���"'S�
Alarm/Remote Control � �A ' – �Z' ��
Swimming Pool � ��-,��� �
I hereb ceAi ihaf I ins eded ihe eledrical installa}ian described ei on th fes ta d
Irrigation Boom Rough-In . '� � ��
Special Inspe "" "' _ �
finol �O}
Investigative Fee � —"
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
2 9 9- 415 � OFFICE USE ONLY This request void 18 months from validafion date printed in this box.
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PLEASE PRINT OR TYPE � - ��
Request Date I� Rough-in inspedion required2 Yes ❑ No Inspedion Other Than Rough-In: ❑ Ready Now Will Call
Z� (You must call the inspedor when ready) Date Ready:
I, ❑ licensed contractor owner hereby request inspection of the above electrical work at:
Job Address (Sfreet, Box, or Rouie No.) Cify �. Zip Code
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$edion No. Township Name or No. Range No. Fire No. C n1y
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Occupa Phone No.
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Power Suppli r Address
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Elecirical ConTrador (Company Name) ontrador License No. Master Lic. No. (Planf Elect. Only)
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Mailing Address (Confrador or Owner Performing InstallationA) �
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Au orized Si oture �Contrador or O ner Perfo ing Installafion) ��� �� `e �� Phone No.
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EB-0 /95 ST TE BOARD COPY - SEE INSTRUCTIONS ON BACKOF YELLOW COPY