P - 80714REQUEST FOR ELECTRICAL INSPECTION
6 O"•� �' �`� � 8'21 University A ea,rRm. S-12r8,ISt. Paul, MN 55104
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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 reqjuest. Enter remarks in this space and on the back of the white� py only.
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Calculate Inspection Fee - Th�s Inspection Req��est 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/Generato� INSPECTOR'S USE ONLY TOTAL,/� �
Sign/Outline Ltg. Xfmr. %V • --
Alarm/Remote Conhol
Swimming Pool
I her certi that I ins the elecfrical insfallafion described herein on tha dafes stated
Irrigation Boom Ro�Mn Dor�.- r 2_��
Speciallnspecti - C9
Investigative Fee F��I
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MO�iT .
OFFICE USE ONLY This request void 18 months from validation date printed in fhis box.
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PLEASE PRINT OR TYPE ��
� Request D Rough-in inspection required? Yes ❑ No Inspection Other Than Rough-In: ❑ Ready Now 0 Will Call
J �`O 99 �ou musf call the inspector w en ready) Date Ready:
I, �licensed contractor ❑ owner hereby request inspection of the above elecfrical work at:
Job Address (Skeef, Box, or Roufe No.) City ♦ � Zip Code
73�/ %�'� o Tc r'�'i►� /1/ �'r� R�/e � ,SSy"3 �
Section No. Township Name No. Range No. Fire No. Cou
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Power Supplier Address
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Elecfrical Confracfor �Company Name� Conhacfor License No. Master Lic. No. (Plant Elecl. Only)
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Mailing Addre Conhacfor or Owner Pe�ing Installafion
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Authorized Signatur o actor or Qwner Pe ' g I fallafio � A P one No.
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EB-00001 A-11 8/9 STATE BO D COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY