P - 82642( IIII !fi� II III II II� II III (I II II III II III (I I�� I II�I ME�esota Ssi O Be. dRm. S-ic BASt.I PauPl, MNT5O5 04 ��V�a
18 U ty �'�r�.;�;�
�� 0 3��� 4 6 7* Phone (612) 642-0800 �
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Re air
Air Cond. Htg. Equip. Water Htr. ad Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"k' above the work covered by this requesf. Enter remarks in this space and on the back of the white copy only.
Colculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Olher Fee # Service Enirance Size Fee # Circuiis/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 INSPECTOR'SUSEONLY
'T�1TAL �Q
Sign/Outline Ltg. Xfmr.
Alarm/Remoie Control
Swimming Pool
I hereb certi ihat I ins eded fhe eledrical installation described herein on }he dates stated
trrigation Boom Rough-In Date
Special Inspecti �� Dare
Final /� � ��j
investigative Fee �^—
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
3 2 3- 3 4 6 � OFFICE USE ONLY This request void 18 moMhs from valida}ion date prinied in this boz.
�
� �
PLEASE PRINT OR TYPE � r ��� Z
Request Date Rough-in inspedion required2 s � No Inspedion Other Than Rough-In: � Ready Now � Will Call
� l�- ` (You musf wll ihe inspector when reody) Date Ready:
I, icensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address ($treef, Boz^, or Route No.l n , City � Zip Code
II]� /, � �.A.�ti� �w I�M�.. /�'MM li. twI/'1 �
o. I Range No. Fire No. Counly /
�/
Phone No.
Addre:s
Elecfnwl Confmdor (Company
' " — - ' 3100-225TH ST. , FG'
Mailing Address (Contradord.�rr performi g Installafion) �
V i1R: G1I
��iOrJ9 NW ���Il.'� � M .LS I'LLSLZ-00:8 � •
Authorized ntradoror I Q� A
�J �!
EB-OOOOlA-10 6/95 . STATE BOARD COPY- SEE INSTRUCTIONSON BACKOF YELLOW COPY
Lic. No.