P - 82645I I6II �I 1�� II III I� II� !I II II II II III II III �� III I IIII MEn�esota StatOAve. REm. S-�1c BASt.I PauP MN 505104
6 1821 Universdy , ,
' * 0 3 � � � � 9 1 * Phone (612) 642-0800
Home Duplex Apt. Bldg. Other: New
Commercial Industrial Farm Remoc
Air Cond.?� Htg. Equip. Water Htr. Load Mgmt. Other:
ryer J��� Ran e�7 Elec. Heat Tem . Service
"X" obove the work covered by this request. Enter remarks in this space and on the back of the white copy
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Olher Fee # Service Enirance Srce Fee # Circuiis/Feeders
Mobile Home Park Stall to 00 Am 0 to 100 Amps
$ireet Ltg./lraffic Sig. Above 200 Amps Above 100 Amp<.
Transformer/Generator INSPECTOR�SUSEONLY TOTAL
$ign/Outline Ltg. Xfmr. �
Alarm/Remote Control �����
�€T"e�,�,�
.;� ��
Addn
Fee
Swimming Pool n �+
I hereb ceAi }hot I ins eded the eledrical ins}allaiion described here�on 1h�ates�tatEd�
Irrigdtion Boom Rough-In �at5
Special inspe ' - /�' 1 �' ��6
�' Finol Dat '-,. -�
Investigative Fee ��
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
3 2 3- 3 4 9� OFFICE USE ONLY This request void 18 months from validation date printed in }his box.
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PLEASE PRINT OR TYPE Z
Request Date Rough-in inspecfion required2 Yes � No Inspedion Other Than Rough-In: � Ready Now Will Call
1`� aO �� (You must call the inspedor when reody) Date Reody:
I, licersed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Addreu (Sireet, Box, or Route No.� � City Zip Code
I 9 '
,
Sedion No. Township Name or No. Range No. Fire No. Counh
Power $upplier
�
Eledrical Contrador (Company N
Mailing Address (ConTrodor or O
Authorized Signature
EB-OOOOlA-10 6/95
Address
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1 Phone No.
No. Masfer Lic. No. (Plant Elecf.
or cwner rertortnieg mstaimeon) � • ) �
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STATE BOARD COPY- SEE INSTRUCTIONSON BACKOF YEL
Phone No.
COPY