P - 81487, I IIII ��I III I) III IIlI) IIIII II III IIII) II III I IIII 821�Unitv sity Ave., Rm� S-�1I 8AS IpaulP, MNT55104 wu.0 ..�` A
* 0 2 1 6 3 8 0 6 * Phone (612) 642-0800 �
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Form emod 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. Enter remarks in this space and on the back of the white copy only.
.,�/f.-�� / " /��'' or� ��c�v��`.� 5'�+/�. �.�
Calculate Inspection Fee - This Inspection Requesf will not be accepted without the correct fee:
OtFier Fee # Service Enhance Sae Fee # CircuiYs/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'SUSEONLY TOTAL �
$ign/Outline Ltg. Xfmr. ��
Alarm/Remote Control
Swimming Pool
I hereb certi thaf I ins acled ihe elechital installofion described herein on the dates sMted
Irrigation Boom Rough-In Date
Special Inspe
Finol
Investigative F
THIS INSTALLATION MAY BE ORDERED DISCON CTED IF NOT COMPLETED WITHIN 18 MONTHS.
2�C�/� O O� OFFICE USE ONLY This request void 18 monlhs from validation date printed in this box.
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J"
�Ob�
PLEASE PRINT OR TYPE
Request DaM Rough-in inspedion required2 � Yes �' :No Inspecfion Olher Than Rough-In: Ready No il� Call
� Z .� (You must call the inspedor when ready) DaTe Ready:
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
!
Section No. ownship ame or No. Range No. Fire No_ Co ,
Phone
Power3u lier Address
Elecfical Con cfor (Company Na� Coniractor License No. Moster Lic. No. (Plant Elecf.
/
Mailina Addrcss IConfrador or Owner Perfortnina Installafionl
- ♦ .
Authonz igna (Confrador or Owner Pe Insfillafion) �� � Phone No.
EB-OOOOlA-10 6/95 D COPY E INSTRUCTIONS ON BACKOF YELLOW COPY