P - 82147REQUEST FOFi ELECTRICAL INSPECTION �
`�"°' �-19 8� in821eUniversaty A earRm. Se128,ISt. Paul, MN 55104 �
` Phone (612) 642-0800 '�
Home Duplex Apt. Bldg. Othe/r• O� New Addn
Commerciai Industrial Farm `' �j��` c�c � Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above ihe work covered by this request Enler remarks in this space and on the back of ihe white copy only.
Cplculate Inspection Fee - This Inspection Request will rot be accepted wit(�out the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Troffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR�s Use ow�Y TOTAL J
Sign/Outline Ltg. Xfmr. [-��
Alarm/Remote Conhol
Swimming Poot I hereb certi that I' s ed the elechical installation described herein on ihe dates stated
Irrigafiion�B m RougMn Da
Special `'��
Finol Da __.
Investiga
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validation date printed in this box.
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PLEASE PRINT OR TYPE
Request Dafe Rou h-in ins fion r uved$ Yes
g pec eq ' � ❑ No Inspection Ofher Than Rough-In: ❑ Ready Now �Will Call
�— 15 Q v �You must mll the inspector when ready) Date Reody:
I, ❑ licensed contractor � owner hereby request inspection of the above electrical work at:
Job Address j5heet, Box, or Roufe No.� Ciiy /' Zip Code
� q� Ll."F�l � IJ �. f' I� l l> L� � ��. �e�' Z
Seclion No. Township Name or No. Range No. Fire No. Counly
3� z� i9�- a� o r��
Occupanf � Phone No.
Gf��n �'f�et� � ��� '7l0 3 - ? 8 3 �o s �9
Power Supplier Address �
/l�s � �'i o/S ��!0� o � � •
Elechical Conhaclor (Company Name) . Conhacfor License No. Master Lic. No. (Planf Elecl. Only�
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Mailing Address (Conhactor or Owner rmm s
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Authorized SignaNre �Controcfor or Owner Perfo ing In � tion� Phone No.
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E A-11 8/96 S7p� BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY