P - 84672I I I ll � II (II II III II III II III II II) II III �I III I IIII 821�Uni ess' OAv a Rm� S-�1' BASt.I PaulP, M`N 550104 � ,��
�Y �,�
.� 0 2 9 9 3 9 a 5* Pnone (st2) sa2-osoo
Home Duplex Apt. Bldg. Other: �',�� �,�, New Addn
Commercial Industrial Farm � S� Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
D er Ran e Elec. Heat Tem . Service
"k' above the work covered by this request. Enfer remarks in this space and on the bock of the whitB copy onfy.
Calculate Inspection Fee - 7his Inspection Request will not be accepted without the correct fee:
Olher Fee � Service Erdrance Size Fee # Ciraiis/Feeders
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Lig./Traffic $ig. Above 200 Amps Above 100 Am
Fee
Transformer/Generator INSPECTOR'S/USEONLY TOTAL C
Sign/Outline Ltg. Xfmr. �%v'1 ��- +��
Alarm/Remote Control
Swimming Pool..
I hereb ceAi that I ins ected the ecfrical installotion described herein on the datee stafed
Irrigdtion Boom Ro�gh-In ,� y
Special . _ � _ . . . _ .. .. ��, ..
.. ...
THIS INSTALLATION MAY BE ORDEREQ DISCOANECi'ED IF NOT COMPLETED WITHM 18 MOI
2 9 9- 3 9 0�] OFFlCE USE ONLY This request void 18 months from validafion date printed in this box.
i 11
�/ �� ��
PLEASE PRINT OR TYPE �
Request Do Rough-in inspedion required2 ❑ Yes � No Inspection Other Than Rough-In: � Ready Now � Will Cal�
��� �� (You must call fhe inspector when ready) Dofe Ready:
I, ❑ licensed contractor�ner hereby request inspection of the above electrical work at:
Job Add ss (Sfreet, Box, or Ro��e No.) City Zip Code
�,3 a �3 �iv� ��. �i� � C.� s <3�
$ection No. Township Name or No. Range No. Fire No. County p�.
� v � /'7�-�����
Occu na�� Phone No.
_1dS� O/� �o�� _
Power Supplier Address
S /
Eletkiml Contraclor (Compony Name) �
C.xJ
Mailing Address Conkador or Owner P ��
Authorized�nature (Contractor or Owner�A�foAning Installafion)
l� 2T�/ 1J/!/1110�-�
No. Mashr lic. No. (PlanT Eled. Only)
Phone No.
��l- 732,5'
EB-OOOOlA-10�95 U STATEBOARD_COPY-SEEINSTRUCTIONSONBACKOFYELLOWCOPY