P - 84663I I�II II III II III �I III �I III II �II I) II) II III I) III I I�II ME�Uota StatOe B a dEof ERI`CA �INSPECTION '�,�TME�
1d21 Urnversdy Ave., Rm. S-128, St. raul, MN 55104
* 0 3 ti 5 6 � 7 4* Phone (612) 642-0800
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm 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.
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Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Olher Fee � Service Entrance Size Fee # Ciraits/Feeders Fee
Mobile Home Park Stall 0 to mps �JJ 0 to 100 Amps ,; �
$treet Ltg./Traffic $ig. Above 200 Amps Above 100 Amps '
Transformer/Generator INSPECTOR'SUSEONLY TOTA� p
Sign/Outline Ltg. Xfmr. � . � �
Alarm/Remote Control
Swimming Pool
I hereb certi that I ins eded }he elecfncal installation described herein on the dates stated
Irrigation Boom Ro�gh-In pofe
Special Inspedion
Investigative Fee Finol pa� Z� A
Co L
THIS INSTALLATION MAY BE ORDERED DISCO ECTED IF NOT COMPLETED WITHIN 18 MONTHS.
315 - 6 8 7 f.� OFFICE USE ONLY This request void 18 months from validation date printed in this box.
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PLEASE PRINT OR TYPE
Requesf Dafe � Rough-in inspedion required2 � Yes � No Inspection Other Than Rough-In: � Ready Now ill Call
� � Q (You must mll the inspedor when ready) Date Ready:
I,� licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Streef, Box, or Route No.) Cily Zip Code
��3 �P;� c,� -r'�e,�A� FR�dC.E
Sedion No. Township Name or No. Range No. Fire No. Counly
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Occupanl Phone No. �
,DAvE W� G� CUn� ST vc i on� f ��- 8�fo 3
Power $upplier Address
N- S< P 3�1 S c-�� Po i�,;-€ �,e �
ElecirimlConkacfor(Com���TTLER ELECTRIC c���CAO5e1 223 MAMO N2�58�9e��o��y�
Mailing Address (Confracior or Owner Performing Installafion�
1240 46th Ave. N.E., Mpls., MN 55421
Authorized Signafure (Confrador Nner erfo ng In a,�' gIg� Phone No.
Mic ae L.���:�fYer -, 574-9744
EB-OOOOlA-10 6/95 STATE BOARD COPY- SEE INSTRUCTIONS W COPY