P - 84645: I(III �II II III I) III I) III (I III II III II IN II �II I���I g21�Uni ersaO Ae., RE� 3R�ASt.' PaulP, MNTbO5104 ����"
* 2 9 9 3 8 3 0 * Phone (612) 642-0800 ��
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod e air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Oth�`�i4'A fs
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.
�V%�I`� r'4 C� C'-1�{�}/t/CaG o•i 1
Calculate Inspection Fee - This Inspection Request will not be accepted without ihe correct fee:
Other Fee #F $ervice Enlrance Size Fee # Circuits/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 INSPEC7oR's usE oNLY TOTA� e: L—�
Sign/Outline Ltg. Xfmr. ,� �
Alarm/Remote Control
Swimming Pool
I hereb certi lhat I ins eded }he eledrical insfallafion described herein on the dates sia�ed
Irrigation Boom Rough-fn Dare
$pecial Inspecti
Investigative Fee - F��� �----`— - � � �
THIS INSTALLATION MAY BE ORDERED DISCON F NOT COMPLETED WITHIN 18 MONTHS.
2 9 9�� H 3 I 1) I OFFICE USE ONLY This request void 18 mo�ths from validafion date printed in this box.
�irS i��
PLEASE PRINT OR TYPE
Request �S Rough-in inspection required2 ❑ Yes [�"�lo InspecKon Other Than Rough-In: g eady Now � Will Coll
�'��(.,�� 9 (You must call the inspecfor when reody) Dak Ready:
I, licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Bor, or Route No.) Cify Zip Code
E,Z� i3 C�}A�c_ C�F�. IJ� ��t�D�E�I SSy3Z
Secfion No. Township Name or No. Range No. . Fire No. Counly
_.�� �.? �4N � �4
Occupant Phone No. Z — ' � � �
s .� S ��J /11h�1 �.E 5 �7
Power $upplier ' Address
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EI wl Conkactor (Company Name) Gonirador License No. Master Lic. No. (Plant Eled. Only)
�iuTE�� iS� ��� �L Z.7S3
Mailing Addross (ConhacTor or Owner Pehorming Installafion)
Z7 806 �!� C-,� D I��T/ l'�IN S�'D D
Authorized ' ature (Co cror or Owne Perfo in Ila' ) Phone No.
y - 3�.s"�
EB-OOOOIA 6/95 ST/t7E BOARD COPY- SEE IN BACKOF YELLOW COPY