P - 84667I��IIII�III IIIIIIIIIII�III III�I IIII) IIIII IIIII 8P1�Un' erssity Ave., Rm� SRi BASt.'PaulP, MNT55O104 �����"
�� * 0 3 3 1 7 9 7 1 * Phone (612) 642-0800 ����'�
ome Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmi. Other:
Dryer Ran e Elec. Heat Tem . Service $ 'z'—
"k' above the work covered by this request. Enter remarks in this spoce and on the back of the white copy only.
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Olher Fee � Service Enirance Size Fee � Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
$treet Ltg./Traffic $ig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'SUSEONLY TOTAL 1�
y
Sign/Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
I hereb cerfi thaf I ins ected fhe eledricol installafion described herein on fhe dates stated
Irrigation Boom Rough-In C
$pecial Inspect� � 7
final
Investigative F '
THIS INSTALLATION MA BE ORDERED DISCON CTED IF NOT COMPLETED WITHIN 18 MONTHS.
3 31 — 1 V� � OFFICE USE ONLY This request void 18 months from volidation date printed in this box.
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PLEASE PRINT OR TYPE �� �
Request DaM Rough-in inspecli required2 �Yes ❑ No Inspeclion Other Than Rough-In: 0 Ready Now �.�Nill Call
J�.� (You must call ihe inspedor when ready) Dote Ready:
I, �Jicensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Strcet, Box, or Route No.) City Zip Gode
4 p 3's��l
$ecfion No. Township Name or No. Range No. Fire No. County
Address
Elechical Contracfor (Company Name)
F [:f �? �_ /N L
Mailing Addrosa.(Conhaclor or Owner Performing Installation) �
9
Au orized Signafare (Contra r er Perfortning Insmllation)
EB-OOOOIA•10 6/95 STATEBOARDCOPY- INS1
/ �- 0'7 �-y
Conirador License No. � Mashr Lic. No. (Plant Eled. Only)
; 5 2 2 U Phone No.
ON BACK OF YELLOW COPY