P - 84751RE(.IUEST FOR ELECTRICAL INSPECTION
y� I' I III II III II III I) III II II) II III II III II III I(III S121 Uni essity AvearRmf S-1281cSt. Paul, MN 55104 �;
* 0 2 2 B 5 8 7 2 * Phone (612) 642-0800 ��
Home Duplex Apt. Bldg. Other: New Addn
Commercial Indusirial Farm Remod Re air
IAir Cond. I I Htg. Equip. I I Water Htr. I I Load Mgmt. � Other.
Dryer Range Elec. Heat � � Temp. $ervice �
"X" above the work covered by this request. Enter remarks in this space and on the
copy
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Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Olher Fee � Service Erdrance Size Fee # Circuiis/Feeders
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
$treet Ltg./Traffic $ig. Above 200 Amps Above 100 Am
Trans{ormer/Generator INSPECTOR'S USE ONLY TO �
$ign/Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
I hereb cerfi fhat I ins ected fhe eleckical insfallaiion described herein on fhe date:
Irrig6tion Boom Rough-In Da�e
$pecial Inspedi i , : �
Fee
�s
L ,5..�
�
siated
�Final ... �a _ Z y
Investigative Fee � - /-`
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 16 MONTHS.
2/� Q� C Q� � OFFICE USE ONLY This request void 18 months from validation date printed in this boz.
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PLEASE PRINT OR TYPE
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Requesf Date Rough-in inspedion required2 ❑ Yes [�No Inspecfion OtherThan Rough-In:�Ready Now � Will Call
(You musf call The inspedor when ready) �` Dafe Ready:
I,'�licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sfreet, Box, or Rou City Zip Code�
�5 � � �9-�1� �� �R � � ssY32
Sedion No. Township ame or No. Range No. Fire No. County
�O l�i�-
Phone No.
t� S �-t�,�2-
Power $upplier I Address
EI 'wl Conhador ompany N �J �
i ing Ad ss (Cont do� or Owner erforming Installation �
Authoriz i naW6lContracforor ne erformiominstallationl
Master Lic. No. (Plant Eled. Only)
EB-OOOOtA-10 6/95 // STATE BOARD COPY- SEE INSTRUCTIONSON BACKOF YELLOW COPY