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P - 84756I I�� III I) III II III (I II) II III II III I) II) I� �I) I��II g2���N SsaOAve., Rm� S-�1 BASt.I PaulP, MNT55O104 u� : r* 0 2 9 9 3 5 6 6 * Phone (s� 2) s�a2-o Home Duplex Apt. Bldg. Other: c 1� New Addn Commercial Industrial Farm '� J Remod Re air Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other: Dryer Ran e Elec. Heat Tem . Service "X" above the work covered by this request. Enter remarks in this space and on fhe back of the white copy only. Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee: Olher Fee # Service EMrance Size Fee # Circuits/Feeders Fee Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps ,C� Street Ltg./Traffic $ig. Above 200 Amps Above 100 Amps Transformer/Generator INSPECTOR'SU�ONLY / TOTAL ` L�.� $ign/Outline Ltg. Xfmr. �- �� �� �-�- ��"" �r�f � " J Alarm/Remote Control Swimming Pool I hareb cerfi fhaf I ins ecfed ihe el ' al installation described herein on the dates sTated Irrigation Boo � • Rough-In °� � / � l � $pecial InspecFion � _�� Final Da � Investigative Fee `—" THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 16 MONTHS. 2 9 9- 3 5 6 OFFICE USE ONLY This request void 18 months from validafion daM printed in this box. � � �r�� ��� PLEASE PRINT OR TYPE Request Date Rough-in inspedion required2 �Yes � No Inspecfion Other Than Rough-In: � Ready Now Will Call �—' � r7 �� (You musT call the inspedor whe ready) Date Ready: I, ❑ licensed contractor owner hereby request inspection of the above electrical work at: Job Address (Sheet, Boz, or Route No.) City Zip Code � ffE«ti� �/ y� f,�'�v�c>' S5 �/3Z Secfion No. Township Name or No. Range No. Fire No. County � � As� o,��q Occupant Phone No. /" �/�/�� S �r3�,e � S 7�/- 9��.3 Power Supplier -` Address /� �s i ^/ v /V �(/ /`/ v c Elecfrical Confrador (Company Nome) Contractor License No. Master Lic. No. (Planf Elecf. Only) Mailing Address (Contractor or Owner Performing Insrollation) .�� Authoriz ature (Contmdor wner rfo,ming Instollotion� - `) �. p Phone No. � 7`/- 9d".� EB-OOOOlA-10 6/95 STAT BOARD COPY- SEE INSTRUCTIONS ON BACKOF YELLOW COPY