P - 83635I IIII II II) II ��II III II III I� III II II) I) III I� I�) I I��� MEn�esota StatO Bo dEo ER cCA �INSPECTION ���
1821 Unroersity Ave., Rm. S-128, St. Paul, MN 55104 � �,�
*.- 0 3�: 9 9� 6 9* Phone (612) 642-0800 �r����"'�
Home Duplex Apt. Bldg. Other.s �` �� New Addn
Commercial Industrial Farm Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Ran e Elec. Heat Temp. Service ���`L� V'$ � N
"X" above the work covered by fhis request. Enter remarks in fhis space an on he back of th e opy only.
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Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee: �� p
Other Fee # Service Enha Fee # Circuih/Feeders ,�.1(�
Mobile Home Park Stall 200 Amps ` 0 to 100 Amps
$treet Ltg./Traffic Sig. Above 200 Amps �, (J Above 100 Amps
Transformer/Generator INSPECTOR'SUSEONLY TOTAL
$ign/Outline Ltg. Xfmr.
Alarm/Remote Control ����
Swimming Pool
I hereb certi that I ins eded ihe eledrical installation described herein on ihe dates stated
Irrigdtion Boom Roogh-In Dar�, � C,>
Special Inspe ' ' �
Final � ,+��� %
Investigative F �L-- � /
THIS INSTALLATION MAY BE ORDERED DISCON CTED IF NOT COMPLETED WITHIN 18 MONTHS.
319 - 9 5 6 OFFICE USE ONLY This request void 18 months from validation date printed in this boz.
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PLEASE PRINT OR TYPE
Request Date Rough-in inspection required2 �es � No Inspection Other Than Rough-In: � Ready Now �JJill Call
$� +.. Gj � (You must wll }he inspedor when ready) Dafe Ready:
�, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sfreet, Box, or Route No.) City Zip Code
3Y� :2��� c2���T %'E�r�qeE %Ri�eE �5 Y z
Secfion No. Township Name or No. Range No. Fire No. County
Occupant �� y/� Q�� �� V S Phone No. !o � Q
r� z - Z �
Power Supplier Address g 3d ,,, ij ,�' (� Z
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Eledrical Contrador (Company Name) Coniractor License No. Master Lic. No. (Plant Eled. Only)
1�� /3 � lN s� c. cr c c a� �
Mailing Address (ConTracfor or Owner Perfortning Installation)
L3 2 t,�+ t� s�► .�. ��- .v� /L!D c. s �i a 3 S Y/ 8
AuThorized ' nature (Contra or Own rfo n Installation) � t� �� A Phone No.,�' 7 �
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EB-OOOOlA-10 6/95 STATE BOARD COPY- SEE INSTRUCTIONSON BACKOF YELLOW COPY