P - 80725REQUEST FOR ELECTRICAL INSPECTION
1 J�— 3 7 3� 1�821 University A earR pf SIe12$ ISt. Paul, MN 55104
Phone (612) 642-0800 `'�'
Home Duplex Apt. Bldg. Other: New Addn
Commercia{ Industrial Farm Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above ihe work covered b this request. Enter remar�CS in t4 is �sp an on he 4ack of the hite co only.
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Calculate Inspection Fee - This Inspection Request will not be accepted withoui the correct fee:
Other Fee # Service Entrance Size Fee # CircuitsfFeeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
TransformerJGenerator INSPECTOR'S USE ONLV TOT
e
Sign/Outline Ltg. Xfmr. �r�r
Alarm/Remote Control � ` � G's„i.
Swimming Pool I hereb certi fhat I ins ected the elechical installation described herein on the dates stated •L`J�
�fflgafiOn . j : Rough-In - Date
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Speciallns ct �
Fina�� � ,.,�
Investigative Fee
THIS INSTALLATION MAY BE ORDERED DISCONNECTEf� NOT COMPLETED WITHIN 18 MONTHS.
OFFlCE USE ONLY This �equesf void 18 months from validation dafe prinfed in fhis box.
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PLEASE PRINT OR TYPE
Request Dafe Rough-in inspeclion required? ❑ Yes No Inspection Other Thon Rough-In: eody Now � Will Coll
I � (You musf call }he inspector when ready) Date Ready:
I, �licensed contractor ❑ owner hereby request inspection of the above electrical work at:
1ob Address �Street, Box, or� oute No.j Ciy p � Zip Code
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Secfion No. 7owns ip Name or No. Range No. Fire No. County
Occupant ` � ] � j�/� ` � �� Phone No,. '
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Powsr Supplier Address
Elechical Conhactor (Companv Namel Conhacror License No. _ Master Lic. No. IPlanf Elect. Onlyl
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STATE BOARD COPY - SEE INSTRUCTIONS OIwCK OF YELLOW COPY