P - 84335I��I II III II III II II��I I� II II II II) II III �� I�) I�III gE�UE� SsaO Be dR o SRI 8p►S .' PaulP, MNT55O1o4 �����
* 0 2 9 9 3 5 5 8* Phone (612) 642-0800 °�� �
Home Duplex Apt. Bldg. Other: New Addn
' Commerciai Industrial Farm emod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other.
Dryer Range Elec. Heat Tem . Service
"X" above the work covered by this request. Enter remarks in this space and the back of the white copy only.
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Calculate Inspection Fee - This Inspection Request will not be accepted without t correc� iee:
Ofher Fee # Service Entra 'ze Fee # Circuits/Feeders
Mobile Home Park Stall 0 t mps-,r 0 to 100 Amps
Sireet Ltg./Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR�SUSEONLY TOT �
Sign/Outline Ltg. Xfmr.
Alarm/Remote Control
$wimming Pool
I hereb certi that I ins eded the eledrical installation described herein on ihe dates stafed
Irrigdtion Boom Rough-In �a}e
Special Inspedion
Final D -
Investigative Fee
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MO
2 9 9- 3 5 5� OFFICE USE ONLY This request void 18 months from validation da}e printed in ihis box.
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Fee
PLEASE PRINT OR TYPE
Request Dafe Rough-in inspecfion required2 � Yes � No Inspedion Other Than Rough-In: � Ready Now � Will Call
Z, .� l v ,/ (i'� � (You musf coll the inspedor when ready) Date Ready:
I, ❑ licensed contractor owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Rout No.) City ,i Zip Code
f - � A� �,' ' �o��. � �, � ( 3 z-
$edion No. Townsh�p Name or No. Range No. Fire No. Counh
Occupanf
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Power Supplier `�
�' 1
ElecFrical Confrador (Company Name)
Mailing Address (Conirador or Owner Perfortning
Authorized Signaf��C�nirodor or �vner Perf�mig�j Insfallafion)
Phone No. /
-�� 1 �- �/ ��� �
Conhador Licen �� t�� S�� 9aster Lic. No. (Plant Eled. Only)
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P�'I 1 -�1 �7 �J�
EB-OOOOlA-10 6/95 §TATE BOARD COPY- SEE INSTRUCTIONS ON BACK OF YELLOW COPY