P - 83622II��II �N�� II) I I!�I III I� �II I� III II (II (� ��I ((��) MELnl� ° a StatOe B a dEof ER cCA �INSPECTION �,����
ii21 University Ave , Rm S 128, St Paul, MN 55104 � �'
� 0 3 1� � 6`3 4 0* Phone (612) 642-0800 ��n'�.��
ome Duplex Apt. Bldg. Other: New Addn
ommercial Industrial Farm Remod e air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer an e Elec. Heat Tem . Service
"k' above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
��,►,A�r �; �
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Olher Fee # $ervice Entrance Size Fee # Circuih/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'SUSEONLY TOTALS S�
Sign/Outline Ltg. Xfmr. � �
Alarm/Remote Control
$wimming Pool
I hereb ceAi that I ins eded ihe eledrical installation described herein on ihe daies stated
Irrigation Boom Rough-In �°te
Special Inspedi
Final _� - � � � j
Investigative Fee
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
315 e 6 9 4 OFFICE USE ONLY This request void 18 monihs from validafion date printed in this box.
J� � ,, �.�/�,�'
PLEASE PRiNT DR TYPE
Requesf Date � Rough-in inspecfion required2 � Yes �No Inspedion Other Than Rough-In: Ready Now ❑ Will Call
� 3 6 q� (You must call the inspedor when ready) Date Ready:
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sireet, Box, or Roufe No.) ���, City Zip Code
�s�3 �2�c� cK ��,�E F��d�Ey
Sedion No. Township Name or No. Range No. Fire No. County
o«�Pr�c��L �' S� �
u SO N
Power Suoalier
Contracfor
Mailing Address
���
Phon� � /' �D � ^
<,
Address
Company Name) Conirador License No. Masfer Lic. No. (Plant Elect. Only)
METTLER ELECTRIC CAO 1223 AMO 2589
itrador or Owner Performing Installation)
1240 46th Ave. N.E. M ls. MN 55421
(CoMractor or eRf'erf in tall ' .('� . ^ n O Phone No.
ti i � }
STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY