P - 84522(IIII�I) (IIII (IIIIIIIII IIIII (IIIIIIIIII�III IIIII 821�Uni e s�OAve. Rm� S-�1I BASt.'PauP MN 550104 /��:'
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.* � 2 9 9 3 6 3 2 * Phone (612) 642-0800 ��
a 1-1ome Duplex Apt. Bidg. Other. Q � New ddn
Commercial Industrial Farm � Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
D er Ran e Elec. Heat Tem .$ervice
"k' above the work covered by this request. Enter remarks in this space and on the bock of the whita copy onfy.
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Olher Fee � Service Enirance Sae �e # Ciraiis/Feeders Fee
Mobile Home Park Stall 0 0 to 200 Amps � 0 to 100 Amps
$treet Ltg./Traffic $ig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'sus oNLY TOTAL /
Sign/Outline Ltg. Xfmr. �lZ� �!'�
Alarm/Remote Control ��
Swimming Pool
I hereb certi that I ins ecfed fhe eledrical insMllation described herein on the dates stated
(rrigation Boom Rough-In ' �^
$pecial Insp 7 �-���`— ' � � l �
Final Date
Investigative ee
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
2 9 9- 3 6 3 OFFICE USE ONLY This requesf void 18 months from validation date printed in this boz.
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PLEASE PRINT OR TYPE ���
Request te Rough-in inspedion required2 es � No Inspedion Other Than Rough-In: Q Ready Now ill Call
y� 2 , (You must ca�l the inspedor when ready) Date Ready:
I, ❑ licensed conirador [�owner hereby request inspection of the above electrical work at:
Job Address (Sheet, Box, or Rouf o.) City �, Zip Code
3�� R�c �e�,�K a�✓o �'/Zl�c � 3z
Sedion No. Township Name or No. Range No. Fire No. County
3� � ��a�,�
Occupanf r , / Phone No.
�1 o i� .v V� h 7�' 1���
Power Supplier Address
�'U S P t'� p� 1�� � d�l�
Eledrical Coniractor (Company Name) Contrador License No. Master Lic. No. (Plant Eled. Only)
ow t 2
Mailing Addross (ConTracfoi or Owner Performing InsTallafion)
Authorized Signature (Contrador or Owner Perf ing Insfallofio Phone No.
Q � � .�ll�— � � � �7�f .. �'66`f
F° '" "'05 STATE ARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY
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