P - 84727I IIII��I II III II III II III I) II) II II) O III I� II� � I��I g21�UnitversaOAve. dRm. SR128ASt.I PauP MN 5O51pq ��
,� 0 2 9 9 3 9 6 2* Pnone (s� 2) s�a2 � � ' '�'�
Home Duplex Apt. Bldg. Other: � ` '/ New Addn
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Commercial Indushial 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 bock of the whita copy only.
Colculate Inspection Fee - This Inspection Request will not be accepfed without the correct fee:
OHier Fee � Service Enirance Sae Fee #� Circuils/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic $ig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'SUSEONLY TOTAL �
$ign/Outline Ltg. Xfmr. � �• ���
Alarm/Remote Control
Swimming Pool
I hereb certi fhaf I ins ecied the eledric insfallafion described herein on the dafes sfa�ed
Irrigation Boo�-- Rough-In ' �.e��� t�
$peciallns " - -�
Final �_ _�c-� �-
Investigative ee �
THIS INSTALLATION MAY BE ORDERED DISCONNEC D IF NOT COMPLETED WITHIN 18 MONTHS.
2 9 9— 3 9 6 ��CE USE ONLY This request void 18 months from validafion date printed in this box.
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PLEASE PRINT OR TYPE
Request Date Rough-in inspeciion required2 Yes � No Inspettion Other Than Rough-In: Q Ready Now Will Coll
����. �� (You must call fhe inspecior whe reody) Date Ready: �
I, ❑ licensed controctor �owner hereby request inspection of the above electrical work at:
Job Address SNeef, Bo or�oute No.) Ciiy Zip Code
vF� I 1�� c� Cr- � �r. Fr'i � � sS y3 �
Section No. Township Name or No. Range No. Fire No. County /_
3 o a y /�/lo K a.
Occ� ant Phone No.
��►oma � %�7�►om so�, S7 / �- � 12� I,)
Power Supplier Address �' � � ^ � / � /� �
NS�' m Ls - N. d> ! �v
�'v,'S�' .
Elechicol Conhador (Compony Name) Contrador License No. Master Lic. No. (Plant Eled. Only)
�W /�lF/Z ,=.:,
Mailing Addrcss (Contracfor or Owner P^rf`rming Insf�llafion) � .-
S �rrl C
Authorized Signo or erf ing Instollafion) ; Phone No. l,
` �r'a'��i�`w
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EB-00001 A-10 6/95 STATE 80 D COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY