P - 83820,.
r REQUEST FOR ELECTRICAL INSPECTION
� v�' O�� � 8'21 University A earRm. Se128,ISt. Paul, MN 55104
Phone (612)642-0800
Home Duplex Apt. Bldg. Other: New Ac
Commercial Industrial Farm Remod e
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 the back of the white copy only.
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Calcvlate Inspection Fee - This Inspection Request will not be accepted withouf 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./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
Sign/Outline Ltg. Xfmr. ��' �
Alarm/Remote Control
Swimming Pool
I hereb certi that I ins ected the elecirical installafion described herein on the dotes stated
Irrigation Boom Rough-In �a�
S ecial Ins e
P P � Final Date� F� Z,�
Investigative e � —�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 A(ONTHS.
OFFICE USE ONLY This request void 18 monfhs from validafion date printed in this box.
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I IIII II �II I) �II (I III I) II ( III (I �II II III I IIII
* O 4 9 L O 8 5 �* PLEASE PRINT OR TYPE /� �
Requesf Dafe Rough-in inspecfion required? ❑ Yes � No Inspection Other Than RougMn: Ready Now ❑ W�II Call
�, t g, �� (You must call the inspector when ready) Date Ready:
I, �licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sfreet, �B^oxI, or R ufe No.) City Zip Code
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Secfion No. Township Name or No. Range No. Fire No. Cou ^
Occupant �
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Power Supplier Address
Electrical Contractor (Company Name
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Mailing A dress (Contractor or Owner Pehor 'ng Installation)
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; uth ' C d Sig re tracror or Owner Perform�ag Iqctallayor�}�� ��
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Phone No.
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Co fractor License No.
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Master Lic. No.
Pho�e No.
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