P - 84631IIIIIIII (�I I��IIIIIIIIIIII IIIIIIIIIIIIIII.IIIII g21�Uorv statOe B ardRo SR 8AS'PaulP, MNT55O104 ,..y�
�Y �
* 0 2 9 9 3 7 9 B* Phone (612) 642-0800 `�'���
Home Duplex Apt. Bldg. Other: /� �, �I�� G, � S' New Addn
�'�.
r'iommercial Industrial Farm `� Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other. �� � Qu��Cj.�
D er Ran e Elec. Heat Tem .$ervice
"k' above the work covered by this request. Enfer remarks in this space and on the back of the white copy only.
�D�,✓�o � �uCuc � %O OFl�' /✓es✓L� C'�*✓S�xvcrc'o,/ Ot./rS��
St�c-�c p„i� �- �c �°€� es fe� (/�'.°`^`S, 7z � bn �.�
!-/�s ,¢ ��,,-� a��-s:
Calculate Inspection Fee - This In�ction Request will not be accepfed without the correct fee:
Other Fee # $ervice Enhance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps /0 DO
$treet Ltg./Traffic $ig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'SUSEONLY TOTAL .
Sign/Outline Ltg. Xfmr. �'l�t/�+�-L /�L ,�� � .�O
Alarm/Rertrote. Conirol
Swimming Pool
I hereb certi that I ins atfed ihe elechical insMllation described herein on the dates stated
Irrigdtion Bd Rough-In Date
Special Insp
Final p� � fe , % -
Investigative Fee t - �
THIS INSTALLATION MAY BE ORDERED DISCONNEC D IF NOT COMPLETED WITHIN 18 MONTHS.
2 9 9_ 3 7 9� OFFICE USE ONLY This request void 18 monfhs from validation date printed in this box.
��
PLEASE PRINT OR TYPE
ar- � �����
Request te Rough-in insp on required2 ❑ Yes � No Inspeciion Other Than Rough-In: 0 Ready Now � Will Call
� 7 � (You musT call the inspedor when reody) Date Ready:
I,� licensed contractor ❑ owner hereby request inspedion of the above electrical work at:
lob Address ($heet, Boz, or Roufe No.) City Zip Code
O�ZO ?'� `=U r9-,.� �✓E ��> � ���f3Z
Seclion No. Township Name o. Ranga No. Fire No. Counly
�� �� �
Occupant Phone No.
� c�7.� r �,Tar�,/ �� �U� — �.$Z
Power Supplier Address
�t/s.° !�. �s �✓o�.� �� v,
Elecirical Conhador (Com y Name) Confrador License No. Ma ter Lic. No. �Plant Eletf. Only)
.s�.,.lL �c w,.�../ S�7 Z
Maili Address (Conirador or Owner Performing InsMllation)
O �d� c. � �r � /�� /��
Huthorized Signature (Con or O erforming ation�� Phone No.
��� - �3 ��
EB-OOOOlA-10 6/95 ATEBOARDCOPY-SEEINSTRUCTIONSONBACKOF LLOWCOPY