P - 81327Q� REQUEST FOR ELECTRICAL INSPECTION �'�'.�
7!.:� - 5 5 8� 8121 Universaty ABear Rm. 3e1 8,ISt. Paul, MN 55104 �
�� Phone (612) 642-0800 -7 �� I. I a�,;i..
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Form
Ofher:
"X" above the work covered by fhis request Enfer remarks in lhis space and on �he back of the white copy onfy.
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Calculofe Inspec(ion fee - This Inspec/ion Reque3t'will nof be a<cep�ed witnouf fhe mrrecf {ee:
Offier Pee # Service Enirance ize Fee # CirwitsJFeeders Fee
Mo6ile Home Pork Sfall 0 fo ps 0 ro 100 Amps
Slreef Lig./Tmffic Siq. A6ove 200_Amps Above 700_Amps
INSPECTOP'S USE ONLY
POOI
I Investigative Fee � �...._.
THIS INSTALLATION MAY BE ORDER
I� I�II Iillll I hliil I�lIIIIII���Ilill
so�e6ssa�:
/ �i«— ij' G�— ( /
DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This reqoesf void 18 monihs fiom wlldation daie prinled In this 6ox.
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- PLEASE PRINT OR TYPE
R�°�� � Rough-In Inspeclion ryuired? es ❑ No Inspecnon Other Tho� Rough�in: ❑ Ready Now ill Call
,S a�'�� �Yov mun call Me inspetlor when reody� Dore Reody:
I, �licensed contmcfor � owner hereby requesf inspection oF the above electrical work at:
l06 Address �Shcer, Boa, or Raure No.� G Zip Code
6Y61 7ltI1IT� DItIVS F�IQl.67.. 11�.h.
or No. I Ranae No.
rew. u.i� �L
No.
11IK-LYN ELfiGTkIG CO. I CA01'L96
y�se Farlc $Ivd. „�HA?1PLIH, ?1H 5531E.
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