P - 84439II��III I�III IIIIIIIIII IIIII II II�II IIII I MEn�esota Stat�e B a dEof ERectrA�INSPECTION :;����
III I I�II 1g21 Unro -
* ��L 9 9 3 3 9 2 * Phone (612S�2-pg00 m. S 128, St. Paul, MN 55104 ._ ._: �
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Home Duplex Apt. Bldg. Other: -�\ New Addn
Commercial Industrial Farm �i �� -SU Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
D er Ran e Elec. Heat Tem . Service
"X" above the work covered by ihis request. Enter remarks in this space and on the bock of the whitE copy onfy.
�-NS��! �LL�GT�L1C/¢� LtJ � (t1Nl,� I �J V P5�'I (ZS
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Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # Service Enhance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
$treet Ltg./Traffic $ig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR's usE ONLY TOTAL � —� )
Sign/Outline Ltg. Xfmr. ��„S,C1
Alarm/Remote Control
$wimming Pool
I hereb ceAi }hat I ins eded the eledrical installation described herein on fhe dafas sMfed
Irrigdtion Boom Rough-In ,,,� pan
Speciallnspe n l Z_ — (
Investigative e i, Final � pa _. �
�� �--�..-t.. ... �.c ._ ... ,
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
2 9 9- 3 3 9 0 OFFICE USE ONLY This request void 18 months from validafion dote pnnted in this box. '
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PLEASE PRINT OR TYPE
RequesT Dafe Rough-in inspection required2 Yes � No Inspecfion Ofher Than Rough-In: � Ready Now Will Call
� Z/% /� �p (You must call ihe inspedor � 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
59�1 I��.st�n„� Sr � J���Dc�y � 55�3 Z
$edion No. Township Name or No. Range No. Fire No. County
C� � �O K,4
Occupant � Phone No.
p� K�s 5� l-� 53 �
Power Supplier Address
C .'
� � �S ! l�l_(L �_
Electrical Confracfor (Company Name) Coniracfor License No. Master Lic. No. (Planf Eled. Only)
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Mailing Address (Confmd r Ow� Performing Insfollation)
Authorized Signature (Con � ctor or Owner erfo g Ins fion) Phone No.
°—`_ 5 � � - 7� 3 �
EB-OOOOlA-10 6/95 STATE BOARD COPY- SEE INSTRUCTIONS ON BACKOF YELLOW COPY