P - 80639I II�I Ii�II II II� II III II III II III II III II III II III I I�II 8E�Uo essaO Be., Rm� S-�1cSASt.I PaulP, MN 505104 ?���V��.v
,'* 0 2'� 9 6 4 2 3 * Phone (612) 642-OS00 ��'����
Home Duplex Apt. Bldg. Other: New Addn
Commercial industria{ Farm Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
D er Ran e Elec. Heat Tem : Service
"k' above the work covered by this request. Ent y�marks in this space ond on the back of the white copy only.
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Olher Fee � Se ' nira Fee # Circuils
Mobile Home Park Stall 0 0 20 mps , 0 to 100 A
Street ltg./Traffic Sig. A ve 200 Amps � Above 100
Transformer/Generator INSPECTOR'SUSEONLY '�
$ign/Outline Ltg. Xfmr.
Alarm/Remote Control
$wimming Pool
I hereb certi lhaf I ins eded the elechirnl installafion described herein �
Irriqation Boom Ro„ah-In
Fee
TOT� ��G� I
DaTe
Finol " ` �
Investigative Fee `''
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTH .
2%(i ���� + OFFICE USE ONLY This rcquest void 18 months from validation date printed in this box.
I J
� �b �
�da 3
PLEASE PRINT OR TYPE
Request Date Rough-in inspection required2 es � No Inspection Other Than Rough-In: 0 Ready Now � Will Call
(You must call the inspeclor whe ready) Date Ready:
I, �jlicensed controctor Q owner hereby request inspedion of the above electrical work at:
Job Address ($treet, Box, or Route No.) Ci1y Zip Code
�°I35
Section No. Townshi a e or No. /"� Ranae No. Fire No. ounlv n
Power Supplier
Elechiml Controcfor (Company Nome)
Mailing Address (Conhncfor or Owner Pedortning I s1
Au 'zed $ignature (Con}ra r or ner e orming
EB- A-10 6195 STATE BOARD
Address
No.
)1��
License No. � Master Lic. No. (Plant Elad. Only)
� �� � Phone No.
� I ���
INSTRUCTIONS ON BACK OF YELLOW COPY