P - 84575Jr11IIIII��IIIIII�IIIIIIIIIIIIIIIII�IIII��III�II 8E1�Uoa s�OAve. Rm. S-�1I BcSt.'PaulP, MN 505104
* 0 2 9 5 1 3 9 0 * Phone (s12) s�a2-osoo
Home Duplex Apt. Bldg. Other: �lew
Commercial Indushial Farm "���-�"� Rem�
Air Cond. Htg. Equip. Water Htr. Load Mamt. Other:
D er Ran e Elec. Heat
X" above the work covered by this request. Ente
�
est will not be accepted without the correct fee:
rvice Entrance S' Fee # Circvils/Feeders
00 Amps ,� 0 to 100 Amps
ve 200 Amps Above 100 Am
OR'S USE ONLY TOTAL
�s
rti thaf I ins ecfed the eledrical installation described herein on fhe dotes sta
Date
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DISCONNECTED IF NOT COMPLETED WITHIN 1 M
LY This request void 18 months from validofion date printed in }his box.
i�
s�' ���
uired2 � Yes No Inspedion Other Than Rough-In: �' Ready No
dor when ready) Date Ready:
uest inspection of the above electrical work at:
City� Zip Code
� � �—� �a SS
nge No. Fire No. Cou _
Phone No.
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dress
Confmdor License No.
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EE INSTRUCTIONSON BACKOF
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Addn
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in this space and on the back of the white copy only.
Calculate Inspection Fee - This Inspection Requ
Oflaer Fee � Se
Mobile Home Park $tall 0 to
Street Ltg./Traffic Sig. Abo
Fee
Transformer,(Generator INSPECT
Sign/Outline Ltg. Xfmr. , � �
Alarm/Remote Control
Swimming Pool
I hereb ce fed
Irrig6tion Boom Rough-In
Special Inspedi s
Final
Investigative Fee d � -
THIS INSTALLATION MAY BE ORDERED ONTHS.
2 9 5-13 9�) OFFICE USE ON
PLEASE PRINT OR TYPE
Request Date Rough-in inspection req w� Will Call
�� s_ Q� (You must call fhe inspe
I, � licensed contractor ❑ owner hereby req
Job Address (Street, Box, or Route No.)
�$� O� � �{ ��
Secfion No. Township Name or No. Ra
a
Po�.
il�c�� lz
nd
tlecfriwl Conhaclor (Company Name) �
� Y� �1 `5 �S� � l�-c�✓1
Mailing re�Co dor or Own� er Perfprtning sfallafion)
�-t-�r a �
AuMo 'z ig fure (Conhador or Owner Perfortning Insfollofio
EB-OOOOlA-1 6/ STATE BOARD COPY- S
Lic. No. (Planf Eled.