P - 83277REQUEST FOR ELECTRICAL INSPECTION
6 O�t` � 5 9 9� 8121 University A ear Rm. Se128,'St. Paui, MN 55104 �
" Phone (612) 642-0800 " `'°�'
ome Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod e air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on ►he back of the white copy only.
,nru s� �o,,�Ys i
Cakulaie Inspection Fee - This Inspection Requesf will not be accepted withou► the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeder.
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Sfreet Ltg./Traffic Sig. Above 200 Am s Above 100 A
Transformer/Generator INSPECTOR'S USE ONLY TOT
Sign/Oudine Ltg. Xfmr.
Alarm/Remote Conhol
Swimming Pool
I hereb cefi that I ins the elecirical installation described herein on the dal
Irrigation Boom R Mo Dare
$pecial Inspection
Investiaative Fee F��
Fee
�S. �✓
THIS INSTALLATION MAY BE ORDERED DISCBAI�ECTED IF NOT COMPLETED WITHIN 18 MOKTHS.
.. OFFICE USE ONLY This request void 18 monfhs 6om validafion dafe printed in this box.
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* 0 6 � 4 5 9 9 1* �J�3
PLEASE PRINT OR TYPE
Request Dafe Rough-in inspeclion required? ❑ Yes No InspecCon Other Than RougMn: Ready Now ❑ Will Call
a���, .�� (You must cail the inspactor when ready� Date Ready:
I, �licensed contractor ❑ owner hereby request inspection of the above electrical work at:
1ob Address (Shcef, Box, or Rou6e No.) City Zip Code
�'13A I'�sn�� � � T-'n
Section No. Township Name or No. Range No. Fire No. C n
� OR�� � i4U l.,t.ts
Power Suoolier
ConhaMOr�Compan����
-�1� �'i5 L
� ress IConhac�or or Owner PerForminaYnstallationl .
Phone No.
sn�._�a-
License No. Masler Lic. No.
� � ��
or Owner Performing Installafion) ' V Phone No.
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STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY