P - 84414hll� ��II II III II III � III I) II) I) II) II II) II II) I I�II ME(�Uota 3ta0 B a dEo ERIC�c�iNSPECTION °�<.... a,
`* D 2 9 9 3 3 6 8 * Phone 612 S642-0800 m. S 128, St. Paul, MN 55104 ��
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ome Duplex Apt. Bldg. Other. �� ��� New Addn
Commercial Industrial Farm Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other. �,� a�. h�Q�,�, a,�
D er Ran e Elec. Heat Tem . Service L�pp� f�U�,_
"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
$treet Ltg./Traffic $ig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'SUSEONLY TOTAL
Sign/Outline Ltg. Xfmr. �� �
Alarm/Remote Control
Swimming Pool '
,��''�� i�f hereb certi that I ins eded the eledrical insfallation described herein on ihe dates sMted
Irrig6tion Boom . Rough-In Date
$pecial lnspecti
Investigative Fee Final _ Dore v Z� �-
_ THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
2 9 9- 3 3 6 OPFICE USE ONLY This request void 18 months from validafion date priMed in this box.
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PLEASE PRINT OR TYPE
Request Daie Rough-in inspedion required2 � Yes � No Inspecfion Other Than Rough-In: Q Ready Now � Will Ca�l
;` (— — (You must mll the inspedor when ready) Date Ready:
I, ❑ licensed contractor�wner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or RouM No.) City Zip Code
�O /4 � ' .� Prr �. %r ' � � S�S� �.
$edion No. Township Name or No. Range No. Fire No. C unly
Occupant � � � �
, Phone No. � (�4�'�-�S�
f' ��- �%%�-�J'
Power Supplier Address � M
S fi !�%' <
E�echicol Conkacior ompony Name) Contrador license No. Master Lic. No. (Plant Elecf. Only)
.�V
Mailing Address (ConTmdor or Owner Performing Installation)
�v f.�� �j �i'''PC� � / P/",�'�' /�� '1��� �S � ,
Authoriz Signa re (CoMrador r Owner1Perfo �' g Installation) � Phone No.
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