P - 84263�'I II 1� il �(I I�I II II) II III II III II I�i II I�� I(��I Mg ��otv SsaOA o dR o S-�1C8ASt.' PaulP, M`N 5O5 04 ���
* 0 2 9 9 3 5 1 7 * Phone (612) 642-0800 ��"�`�
Home Duplex Apt. Bidg. Other: New Addn
Commercial Industrial Farm Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
D er Ran e Elec. Heat Tem .$ervice
"X" above the work covered by this request�nter remarks in this space and on the back of the whita copy
� �1�,1r1 � � ��Z°� �`�-%��o � �
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # $ervice Entrance Size Fee # Circuits/Feeders
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic $ig. Above 200 Amps Above 100 Am
Transformer/Generator INSPECTOR'SUSEONLY TOTp
Sign/Outline Lig. Xfmr.
Alarm/Remote Control
Swimming Pool
I hereb certi ihat I ins ected the eledrical insfallafion described herein on ihe dafe:
Fee
V�
Irrigation Bo Rough-In �a�e
Special Insp � �
Final . �O} �—�//�L
Investigative Fee 6
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
2 9 9- 3 51 0 OFFICE USE ONLY This request void 18 months from validation date printed in }his box.
�
PLEASE PRINT OR TYPE ����� �� �
Request Date Rough-in inspedion required2 ❑ Yes � No Inspedion Other Than Rough-In: � Ready Now ❑ Will Call
��l ���� (You must mll ihe inspedor when ready) Date Ready:
t
I, ❑ licensed contractor.�owner hereby request inspection of the above electrical work at:
Job Address ($treel, Box, or Roufe ) City Zip Code
�^3 %D .��-n��� ����L.� .S�S
$ecfion No. Township Name or No. Range No. Fire No. County
�U �� �Di�I
Occupant
Power
Eledrical
��
npany Name)
�?,� � �/�-_
�or or Owner Performing Insiallation)
�
'
Phone No.
Conirador License No.
/L� NoJ�Plant Eled. Only)
Authorized Si ature (Contrador or Owf er Performing Installation) �'t V/;y i� phone No.
/(' �C i� � C��} l }'� L��� / ��+
EB-OOOOlA-10 6/95 STATE BOARD COPY- SEE INSTRUCTIONS ON BACK OF YELLOW COPY