P - 82667I II�II III �I III �� III II I�I II I�� II III II III II III I IIII �REG1Uota StatOe B a dEof ERI�CA�INSPECTION ������k
1821 Urnversity Ave., Rm. S 128, St. Paul, MN 55104 �
�* � 3 3 0 7 9 1 5* Phone (612) 642-0800 ����� 6�
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Tem . Service
"k' above the work covered by fhis request. Enter remarks in this space and on the back of the white copy only.
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Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # $ervice Enirance Size Fee # Circuiis/Feeders Fee
Mobile Home Park $tall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'SUSEONLY TOTAL
Sign/Outline Ltg. Xfmr. a �o
Alarm/Remote Control
Swimming Pool
I hereb certi that I ins ed he eledntal installation described herein on the dates s}a}ed
Irrigdtion Boom Rough-In Date
$pecial Inspection Z��� ��
Final . Date
Investigative e! �3�—
THIS INSTALLATION MAY E ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
3 3 0- 7 91 0 OFFICE USE ONLY This requesi void 18 monihs from validation date printed in }his box.
•
PLEASE PRINT OR TYPE
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Request�e �� ��� Rough-in inspection required2 � Yes � No Inspection Other Than Rough-In: � Ready Now � Will Call
j(You must call the inspedor when ready) Date Ready:
I, �licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Roufe No.) Ci Zip Code
� � � ^ E�� s � �� iDt�Y ss�3�-
Secfion No. Township Name or No. Range No. Fire No. County
,�-lv���-
Occupant Phone No.
Power Supplier Address
Ele cal Confractor (Company Name) Contrador License No. Master Lic. No. (Plant Eled. Only)
�INCs � G � iC �N� C ' 3 '
Mailing Address (Contrador or Owner Perfortriing Installa}ion)
�0 �I� C 1 C � f�i N �� /�l ,nl 5 �� )1-/
Aut igna}ure ( on dor or Owner Performing Ir�l�llatjpn}-� �, � Phone No.
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EB-OOOOlA-10 6/95 STATE BOARD COPY- SEE INSTRUCTIONS ON BACKOF YELLOW COPY