P - 82683�IIII II �I� (I� II III II III !I I I II III II II) �� ��� I I��I 82Q�ota SsaO Be dR o S-�1°8ASt.' PaulP, MNT55O104 n���
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* 0 2 9 9 3 4 6 7 * Phone (s12> sa2-osoo
ome Duplex Apt. Bldg. Other: New ddn
Commerciai Industrial 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. Enter remarks in this space and on the back of the white copy only.
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee � Service Enirance 5"¢e Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps , Q
Street Ltg./Traf4ic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR's use oN�v TOTAL r
Sign/Outline Ltg. Xfmr. � 6_Z„G �j7 �"�v
Alarm/Remote Control
$wlmminCJ POO� I hereb ceAi that I ins eleclrirnl ' stallation described herein on 1he dates sfaled
Irrigdtion Boom Rough-In �O ,�,�
$pecial Inspedio
Investigative Fee �re � �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 ONTHS,
2 9 9- 3 4 6� OFFICE USE ONLY Thia roqwaf void 18 months from validafion date printed in ihis box.
2.. �—,l �~"i%/ �'� �/
PLEASE PRINT OR TYPE
Request Daie Rough-in inspettion required2 ��Yes � No Inspection Olher Than Rough•In: Q Reody Now �/ill Call
1 p� -��p � 9Gi (You must call the inspedor when ready) Dafe Ready: �
I, ❑ licensed contractor �owner hereby request inspecfion of the above electrical work at:
Job Address (Sireef, Box, or Route No.) City Zip Code
SOS �JA�J�Sv� — �3a
$ecfion No. Township Name o1 No. Ran�No. Fire No. Cou ty
3r�
�«�P°�'t Phone No. �
/ /A)A�, _ /Gnn.. �..n/
� Power Supplier
I Elechical Conhacior (Company Name) / Contmcfor License No. Mwler
(� )�2�
Mailing Address (Contractor or er Performing Installafion)
� Authorized $ignature (CoMracFor or
Phone No.
I I '/tJ J "
EB-00001 A-10 6/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY