P - 84661(I�I � II I�I II III II III II III II II) II II) �I III I(�II 821�U�tv s�OAve., dRm. S-�1 8AS .' PaulP, M`N 55104 ���
* 0 2 9 9 3 8 7 1* Phone (612) 642-0800 � U 2� '��
ome Duplex Apt. Bldg. Other: ,�� � {�lew Addn
Commercial Industrial Farm Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
D er Ran e Elec. Heat Tem .$ervice
"X" above the work covered by this request. Enter remarks in this space ond on the back of the white copy only.
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Olher Fee � $ervice Enirance Size Fee � Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps to 100 Amps
Street Ltg./Traffic $ig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S uSE ONI.Y TOTAL s�}
Sign/Outline Ltg. Xfmr. �� a �i ���(.u,� • ��•
Alarm/Remote Control
$wimming Pool
I hereb certi thaf I ins ecied ihe elecirical insfallafion described herein on fhe dates sTated
Irriga}ion Boom Ro�gh-In pore
Special Inspedio —
_ Final Dn1e � �
Investigative Fee b
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
2 9 9�� 8 7� OFFICE USE ONLY This request void 18 months from validation date printed in this box.
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PLEASE PRINT OR TYPE
Request Date Rough-in inspecfion required2 � Yes � No Inspecfion Other Than Rough-In: � Ready Now � Will Call
_ a � (You must call the inspedor when ready) DaM Ready:
I, ❑ licensed contractor � owner hereby request inspection of ihe above electrical work at:
Job Address (Sheet, Boz, or RouM No.� City Zip Code
�� s. n�E �^.' d I�e s�s �a
Seciion No. Township Nam r No. Range No. Fire No. Coun
� U �. L �%�O/��
Occupanf Phone No.
��► � �- L-C1� � �7/-5 �loc�
Power Supplier Address
-5 I'� J'y1 �/ 5 �'% • f�J�' �l Uv�
Elechical ConTracfor (Company Name) Controcfor License No. Master Lic. No. (Plant Eleci. Only)
G�l� T�l. ��
Mailing Address (Conhactor or Owner Performing InsMllation)
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Authorized Signafure (Con r or Owner Performing In Ilafio ) � t p� No./� .y,
� � � X/_ /1
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EB-OOOOtA-10 6/95 STATE B ARD OPY- SEE INSTRUCTIONS ON BACKOF YELLOW COPY