P - 84641� Illl'I�IIII�IIIIIIIIIIII IIIII IIIII (IIIIIIIII (I�II 82�Uon�iessatOe B a dEof ERIcC�A�INSPECTION ,�ay�
_ dy A., Rm. S 128, St. Paul, MN 55104 �
* 0 2 9 9 3 $ 2 2* Phone (s12) sa2-osoo Q-�,
Home Duplex Apt. Bldg. Other: � � New Addn
Commercial Indushial Farm �� Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other: %�%
D er Ran e Elec. Heat Tem . Service ��� '`��K ��
"k' above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee � Service EMrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps '� 0 to 100 Amps
Street Lig./Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPEC7oR'S USE ONLY TOTAL
Sign/Outline Ltg. Xfmr. , s�
Alarm/Remote Control
Swimming Pool
I hereb ceAi that I ins ected ihe elecirical insfollafion described herein on the dates statad
Irrigdtion Boom Rou h-In Q
Special Inspe � 9 � � ��'`� ` 7
Firwl po}e
Investiga#ive F �/t
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 ONTHS.
2 9 9� 3 8 2 OFflCE USE ONLY This request void 18 moMhs from validation date printed in this box.
/�
3/� S� � %�/� �
PLEASE PRINT OR TYPE
Request te Q/� Rough-in inspection required2 Yes o Inspeclion Other Than ugh- Ready Now � Will Coll
�� -/ / (You must call the inspecfor when ready) Dafe Ready: �/��
I, ❑ licensed contractor owner hereby request inspection of the above electrical work at:
Job�ddr,ss��$hee(,8qa, or Rqute No City Zip Code
� 7 ��T1 i/.L� � F',� ld ��. ��� �-
Section No. Township Name or No. Range No. Fire No. County
�� �� �/D ��4
o anr
�r ��� Phone No.
« ��ao 7 33
Power Suppijerc � Address
/l/ V LS Q.2� /.��U,slv�1
Elechical Con}racior (Company Name) Confrattor license No. Masler Lic. No. (Planf Eled. Only)
�
Mailing Address (Contraclor�Owner� �g I�lation)
/
Authoriz 'gnature (Confracfor or Parforming InsMlloti [ Phone No.
.. _, - ��a d ��.�3
EB-00001 A- 6/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY