P - 82286REQUEST FOR ELECTRICAL INSPECTION
8, L�- 211 � 8'21 Univers� Ave.,rRm. S-12r8,ISt. Paul, MN 55104
f Phone(612)642-0800
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Re 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 the back of the white copy only.
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Calculate Insp ctio�fee -� nl spection �equesf will�nbt be ao�ep ed witfiout�he 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 TOT �
Sign/Outline Ltg. Xfmr.
Alarm/Remote Conhol
Swimming Pool
I hereb certi that I ins ted the electrical installation deuribed herein on the dales stated
Irrigation Boo Rough-In Date
Speciallnspec ti F��ol op�
(nvestigative Fee +�— a �%� "C�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MON7HS.
.. OFFICE USE ONLY This request wid 18 months from validation date prinfed in tfiis box.
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PLEASE PRINT OR TYPE
Request Da Rou h-in ins dion r uired?
g pe eq ❑ Yes o Inspection Other Than Rough-In: eady Now ❑ Will Call
� � (You must call the inspecror when ready) Date Ready:
I, licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address �Street, Box, or Rouk No.) Ciy Zip Code
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$ecfion No. Townsh(�t��prqe� � Range No. Fire No. County
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�«�P°^� Phone No.
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Power Supplier Address
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Elecfrical Conhactor �Company Name� Conhaclor License No. Masfer Lic. No. (Planf Elect. Only)
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Mailin ddress nfractor or ner Performing Insta lation�
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Authorized ' ture �Contractor r Owner Performing Installafion) Phone No. �
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E -11 8/96 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY