P - 80821REQUEST FOR ELECTRICAL INSPECTION -
,� "�—"� 0 � g'21 University A ea,r Rm. S-128, ISt. Paul, MN 55104 �`�
� Phone (612) 642-0800 "�'
Home Duplex Apt. Bldg. Other: New Add�
Commercial Industrial Farm Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Ran e Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
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Calculate Inspection Fee - This Inspection 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
Sfreet Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL r
Sign/Outline Ltg. XFmr. �•' J �
Alarm/Remote Control
$wimming Pool
I hereb certi that I ins ted the elechical installation described herein on the dates stated
Irrigation Boom RougMn Dare
Special Inspect
Final Da
Investigative Fee J ^
THIS INSTAI.LATION MAY BE QRDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requesf void 18 months from validafion date printed in this box.
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PLEASE PRINT OR TYPE
Requesf Dafe I�� Rough-in inspeclion required$ ❑ Yes o Inspecfion Other Than RougMn: eady Now ❑ Will Call
(You musf wll the inspector when reody) Dafe Ready:
I, J�I iicensed contracror ❑ owner hereby request inspection of the above electrical work ot:
Job Address (Street, Box, �o,r,Route No.) � A � Ciy -� � n n Z�P C�de
�ection rvo. I �ownsnip rvame or rvo.
Occupanf
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Power $upplier
Electrical Confroctor �Compony Name�
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Mailing Addr (Conhacror or Owner Perfo
�� t 9 C''��
Authorized Signafure (Conhacfor or Owner
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B-0OOOI A-11 8/96 y�A�
Range No. � fire No. � County
Phone No.
ConhacFor License No.
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� Installafion) � � ^ � �
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COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY
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