P - 83844I II�I I���II II� II III II III II III II III II �II �) II� I I��I ME�Uota StatOe Boa dEof ERI�CA�INSPECTION � ��]
1821 Unroersity Ave., Rm. S-128, St. Paul, MN 55104 �`
,� 0 2 9 9 4�, 0 1 * Phone (612) 642 os ��_»��
Home Duplex Apt. Bldg. Other: ' ` New Addn
Commercial Industrial Farm �'�'' `� " C� Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
D er Ran e Elec. Heat Tem . Service
"X" 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:
Olher Fee # $ervice En Size Fee # Circuih/Feeders Fee
Mobile Home Park Stall to 00 Am � 0 Q 0 to 100 mps
$treet Ltg./Traffic $ig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR�suseoN�v TOTAL �
$ign/Outline Ltg. Xfmr. �S
Alarm/Remote Control
Swimming Pool
I hereb certi fhaf I ins eded fhe elechical insfallation descnbed herein on the dates sfated
Irrigation Boom Rough-In Dafe
$pecial Inspedi �) L�
� Final p � i � Q
Investigative Fee �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
2 9 9- 410 OFFICE USE ONLY This request void 18 mon}hs from validation date printed in fhis box.
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PLEASE PRINT OR TYPE °` �
Reques�ate � •� Rough-in inspedion required2 ❑ Yes No Inspection Other Than Rough-In: ❑ Ready Now Will Call
�-� `J� You must coll ihe inspedor when ready) Date Ready:
I, ❑ licensed contractor owner hereby request inspection of the above electrical work at:
Job Addre„�s (SfoT, Box, r Rou� ), � C�N l, r �
( � /A
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Sedion No. Township Name or No Range No. Fire No. Coun �n _��� �
i,
Occupant
Power Sup ier ��
Eledrical Confmdor (Company Name)
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Mailing Address (ConTrador or Owner
Authorized Signature�Confr�doror
Address
Phone
License No.
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IEB-OOOOlA-10 6/95 STATE�OARD COPY- SEE I�RUCTIONS ON BACK OF YELLOW COPY
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Lic. No. (Plant Eled. Only)