P - 84284��I�II�IIIIIIII IIIIIIIIIIIIIIIIIIII IIIIIIIIIIII�II BEQUEa SsatOe Boa dRo S-�1c8ASt.1Paul�, MNT5O5104
� * 0 3 3 7 4 2 4 6* Phone (612) 642-0800
Home Duplex Apt. Bldg. Other: New
Commercial Industrial Farm Remod
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer 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
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Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Olher Fee # Service Entrance 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 INSPECTOH'SUSEONLY TOTAL
$ign/Outline Ltg. Xfmr. �'��
Alarm/Remote Control
$wimming Pool
I hereb certi fhat I ins eded fhe eledrical insfallation described herein on The dafes stated
Irrigation Boom Roogh-In ���
Special Inspe � ` 2 -- � � �'r
Final
Investigative Fee N —�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
3 3 7° 4 2 4 OFFICE USE ONLY This request void 18 monihs from validation date printed in this box.
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PLEASE PRINT OR TYPE
Request Date Rough-in inspedian required2 �Yes � No Inspedion Other Than Rough-In:� Ready Now ❑ Will Call
(You must call the inspecfor when ready) Dafe Ready:
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Streei, Boz, or Route No.) City • Zip Code
1� � 55���
$eciion No. Township Name or No. Range No. Fire No. County
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Occupanf
Power $upplier
Mailing Address (Confrador or
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EB-OOOOlA-10 6/95
Phone No.
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Add�eSs n
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Name) CoMmdor License No. Master Lic No. (Planf Eled
'�cL'C. \ C.. �00 �L.
�Performing Installation)
r or � Installation) ���� Phone N� �
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STATE BOARD COPY- SEE INSTRUCTIONS ON BACKOF YELLOW COPY