P - 81396� REOUEST FOR ELECTRICAL INSPECTION �r�
'. 41M IIIIIII III IIII II I I I I II III Mg2leUnivessty AearRmf SI128 3t Paul MN 55104 ���
* 0 3 9 2 0 8 9 9* Pnone �sizj saz-osoo ���--'
�ir cond. Htg. tquip. Water Htr. ,( Load Mgmt. Other
)ryer Range Elec. Heat Temp. Service
above the wo�k cove�ed by this requesL Enter remarks in this space antl on the back o/ the white copy
SAVER'S SWITGH ZNSTAiLATION
ulate InspecG'on Fee - 7hls Inspectlwr Raquest wlll not be accepted wfthout the corect /ee'
Olher Fee � Service Entrance Size Fee � Circui4s/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street LtgJTraffic Sig. Above 200_Amps Above 100_Amps
Transformer/Generator MSPEC70p'SUSEONLV TOTA /
Sign/Outline Ltg. Xfmr. ��1, j�*
Alarm/Remote Control
""""",••"'y ' - " I hereby cer��y tliat I inspected �he alec�ncal iris�ailation tlescribeC M1erain on tne tlates staled
� Irrigation Boo RougM1-In Date
;( SpeCial InSpeCtion . iiiQl F'�nai Da
Investigative Fee p —
THIS INSTALLATION MAY BE ORDERED �ISCONNECTED IF NOT COMPLETED WITHIN 7 MON S.
OFFICE USE ONLY Thls request void 18 ma�ihs irom velldaUon tla[e pdc[etl In �hls box.
392-48� � �a6�s �
JC1B NUMBER �l98�ort1+e�5
PLEASE PRINT OR TYPE
Requ�st-0a�� � y� Rough-in trspaction reGUired7 0 Yas [�No I�soection Other Than Rough-I¢ R Feady Now 0 WIII Gall
7t
(Vou must czll ihe Inspecror when raatly) Date Ready:
I, �] licensed contractor ❑ owner hereby request inspection of the above electrical �wrk at'.
Job Address Btreet Box, or Route Na_) Gity Zip Cotle
Zib867 ?TN ST NE FkIPLEY :i5�i:32
Section No. Townshlp Name ar No. pange No. Frs No. CounN
occuo��,
Power Sipplle�
ANUIiA
Phone Na.
Elacirbel Con[rac[or (GOmpany Narnel porvaotor Gcense No. Master Lio. No_ �Plant Elec[. Onlyl
l'
Mailing Adtlress (COMractor or Owner Performing nstallation) ^
A nz ign .h c r o w Pe+dm � a . ' ' ,. � Phone No.
� � ::
E6-00001A-11 Si95 STATE BOARD COPV - SEE INSTRUCTIONS ON BACK OF YELLOW COPV �� � � �