P - 79888REQUEST FOFi ELECTRICAL INSPECTION
V"V �-+3 3 4� 8121 Universaty Ave.rRm. S1e128,'St. Paul, MN 55104 �3
Phone (612) 642-0800 " '
Home Duplex Apt. Bldg. ' Other: New Ac
Commercial Industriai Farm Remod Re
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 Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # Service Entrance S' Fee # Circuits/Feeders Fee
Mobile Home Park Stall to Amp 0 Fo 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
$ign/Oudine Ltg. Xfmr. �0 •�J�
AlarmjRemote Control � � 6 9 � .�:�Y'M � �J
Swimming Pooi �1
I hereb certi thaf I ins fhe elechical installafion described herein on the d J V
Irriaation Boom o,.,,,.i.,., n,.,e
� Imestigative Fee � �...._. � ���,��, �� ZS "`� -�i L
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requesf void 18 months from validafion dafe prinfed in fhis box.
I 1�1i II 111 II Iil II ill If II I II III I I III II III il III i IIII
* 0$ 0 2 3 3 4 3* �"'�a0 ��
PLEASE PRINT OR TYPE
Request Date � Rough-in inspection required2 ❑ Yes ❑ No Inspection Olhe� Thon RougMn: ❑ Ready Now � Will Cafl
��-� (� �`!ou musf call fhe inspecfor when ready) Dafe Ready:
I, ❑ licensed contractor ner hereby request inspection of the above electrical work at:
Job Address (Sheet, Box, or Roufe No.) Cily Zip Code
�'o �.2 (( A i(S6`0`'� L(`� �.l�D C.l`�`'� S.�`� `Z.
or No. I Ronae No. I Fire
Ocwpant
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Power Suoplier Address
Mailing Address (Conhactor w Owner Performing Instaitalion)
w
Phone
Conhaclor License No.
STATE BOARD COPY - SEE INSTRUC710NS ON BACK OF YELLOW COPY