P - 83776I�li�l ll I�I � I�I II III II III II �II II I�I I) III �I ��) � I��I MEG1Uota StatOe B a dEof ER cCA �I NSPECTION ���
821 University Ave., Rm. S 128, St. Paul, MN 55104 ��'
� 0 2� 9 4 0 l, 0* Phone (612) 642-0800 Q`�=�� "'"�
Home Duplex Apt. Bldg. Other: � G� New Addn
Commercial Industrial Farm ��,� , j�', � >" Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
CY/�i`l/'/G.-"L^t //.�% �L�7� '� ��S � �C�-� A �L'iJ4f I �C-f71'r✓�. ��TJ l
� l U � a f� �Oc� ✓t� �b �'� -`.�`'�G c.,�'! si/ � c��� �.
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Olher Fee # Service Entrance Size Fee # Circuits/Feeders
Mobile Home Park Stall 0 to 200 Amps ,(� 0 to 100 Amps
Street Ltg./Traffic $ig. Above 200 Amps Above 100 Am
Fee
Transformer/Generator INSPECTOR�suseoN�v TOTAL
Sign/Outline Ltg. Xfmr. �,���- 2 -� %� !� � �• �
Alarm/Remote Control
Swimming Pool
I hereb certi ihat I ins eded ihe eledrical insiallatian described herein on ihe dates sfated
Irrigdtion Boo Rough-In Date
Special lnspe
Date
Investigative Fee �0� ��Q�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
2 9 9- 4 01 OFFICE USE ONLY This request void 18 monihs from validation date p�inted in ihis box. r� �
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PLEASE PRINT OR TYPE
Request D te Rough-in inspecfion required2 ❑ Yes � No Inspedion Other Than Rough-In: � Ready Now � Will Call
�l � Q��L% (You must call the inspedor when ready) Dafe Ready:
I, ❑ licensed contractor � owner hereby request inspection of the above electrical work at:
Job Address (Streef, Box, or Route No.) City Zip Code
��l�o �1v��0_1�'�1�� �``2� ��i �f��` /I?�fl ���y`��
$edion No. Township Name or No. Range No. Fire No. County
� C? � /�lA���'�4
Occupant Phone No.
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��i a) t�'. t�i�o � l l u Gr� ��,�? �T// s�/- r�'��
Power Supplier Addre s 1 n �
��S � `.S �-)�? � ,��`I J l [1'1 S! c� /�-
Elecfrical Coniradq�(Company Name) Conimdor License No. Master Lic. No. (PlanT Elecf. Only�
Mailing
Aufhorized
EB-OOOOlA-10 6/95
�(_�'�l_���%�- � �
iiractor or Owner Perfortning Installation)
��i�l`i'fEl/.t> �G�i�if2 �l�ll�1C�� , /%%f� ��'i '���-J��l ��
(Conirador Owner Perfom�ing Installafion) ��`,� Phone No.
��'�'�� 4� � �>as � �,�f� a�$ �
S E BOARD COPY- SEE INSTRUCTIONS ON BACK OF YELLOW COPY