P - 84472`�I� �II (I III II III II III II III II III (I II� (I (�1 I IIII M8 1�UNv s�OAve�dRm. S-1 SASt! PauPI,EMN 55104 �u
`* 0 2 9 9 3 5 8 2 � Phone (612) 642-0800 "°��
Home Duplex Apt. Bldg. OTher. ��� � ���"� w Addn
Commercial Industrial Farm / �C.D 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 fhis request. Enter remarks in this space and on the ck of the white copy only.
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Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Ofher Fee � S rvice Enfi�ance Size Fee # Circuits/Feeders F�e
Mobile Home Park Stall to 200 Amps 0 to 100 Amps 1�
$treet Ltg./Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'SUSEONLY TO�� ��
$ign/Outline Ltg. Xfmr.
Alarm/Remote Control ��/ �/`� s �
$wimming Pool �� �^ z- t ��%l
I he26 certi ihat I ins eded the eledrical insMllafion described herein on ihe dafes stafed
Irrigation Boom Rough-In Date
Special Insp n '�
Investigative Fee �— ���Z� /��
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
2 9 9- 3 5 8� OFFICE USE ONLY This request void 18 months from validation date printed in this box.
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PLEASE PRINT OR TYPE
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Request Da Rough-in inspecfion required2 ❑ Yes No Inspettion Other Than R ugh-In: � eady Now �Nill Call
/ L (You must tall the inspedor when ready) Date Ready: � �5
I, licensed contractor� owner hereby request inspection of the above electrical work at:
Job Address (Streat, Box, or Route No.) .� City � � Z'p�s �y�
C ~'� �
$ on No. Township Name or ' Range No. Fire No. Counfy
�C� �? r, o C�4
Ottupant Phone No.
C.�G� � �. �'c`.1'1 � � � - ' �
Power Supplier Addres I
%f� S � �l-1 � l (.��5lQ �J :
Elecirical Conhador (Company Name) Conhador Liceose No. MasTer Lic. No. (Plant Eled. Only)
Mailing Address (Con}mdor or Owner Performing Installafion) �
C� o ��` ' /?� S�S%3
AiAhorized Signature (Con or Owne rfo �� sTalla' � " � P one No.
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EB-OOOOIA-10 6/95 STATEBOARDCOPY SEEINSTRUCTIONSONBACKOFYELLOWCOPY