P - 83587REQUEST FOR ELECTRICAL INSPECTION �
7 J J,� 0 O 1 � 1n821eUniversty Ave.,rRm. S 12r8,'St. Paul, MN 55104
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� Phone (612) 642-0800 `���
ome Duplex Apt. Bldg. Other: New Addn
ommercial dustrial 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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Calculaie Inspection Fee - This Inspection ue will not be accepted without the correct fee:
Other Fee # ice 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/Generator INSPECTOR'S USE ONLY TOTjA�L°
Sign/Outline Ltg. Xfmr. N ' .��
Alarm/Remote Confrol
Swimming Pool
I hereb ceAi that I ins ted the elechical installation described herein on the dates siated
Irrigation Boom RougMn Dare
��HIS INSTALLATIOIV MAY BE ORQERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MQNTHS. _
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OFFICE USE ONLY This request void 18 months from validation date printed in fhis box.
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* 0 7 3 3 0 0 7 9*
PLEASE PRINT OR TYPE
Request Dafe � ��q Rough-in inspection required? ❑ Yes ❑ No Inspection Ofher Than RougMn: Ready Now � Will Call
���� �You must call ihe inspector when ready� Date Ready:
I, censed conhactor ❑ owner hereby request inspection of the above electrical work at:
Job ddreu �Sh �, Box, q RoutqNo.) . Ciy Zip Code
% % % _�
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Secfion No. Township Name or No. Range No. Fire No. County
Occupant /�-� � Phone No. �)
( n �i n�✓l.�o i , i�.��' �"7 / ' ���V
Electrical Conkacfor �Company Nam Co ocfor License No. Masfer Lic. No. �I'lani tlect. l
DEPENDABLE ELECTRIC. INC, � � ��
'I r h n rtni lallafion)
Caon Rapids. MN 5543 .
Aufhorized Signafure �Conhac er Performing I I Phone No.
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EB-00001 - 1 8/96 STA OAR CO Y- SEE INSTRUCTIONS ON BACK OF YELLOW COPY '`