P - 83980' II��IIII��IIII (IIII IIIII III�I IIIII IIIII I�III II��I BEt�UE eSsaOAve., REm. S-�ic8ASt.'PaulP, MNTSO 04 ����s��
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`►; Home Duplex Apt. Bidg. Oth�r. / �' � New Addn
Commercial Industrial Farm �-' c A r= cl (� �• Gt t Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer 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.
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # $ervice Entrance Size Fee # Circuits/Feeders
Mobile Home Park $tall 0 to 200 Amps 'j 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Amps Above 100 AmF
Transformer/Generator INSPECTOR'SUSEONLY TOT�I
Sign/Outline Ltg. Xfmr. o,
Alarm/Remote Control
Swimming Pool
Fee
I hereb certi that I ins eded }he eledriwl installation described herein on fhe dates stated
Irrigation Boom � Roogh-In . Dare � �
Special lnsp
Final Dat
Investigative ee //L¢
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTF
2 9 9- 4 2 4 0 OFFICE USE ONLY This requesf void 18 monfhs from volidation date printed in this box.
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PLEASE PRINT OI� TYPE
Request Date Rough-in inspecfion required2 �$,`Yes � No Inspedion Ofher Than Rough-In: ❑ Reody Now � Will Call
/- ���! � (You musi call the inspedor when ready) Date Ready:
I, ❑ licensed contractor j� owner hereby request inspection of the above electrical work at:
Job Address (Sireet, Boz, or Rovte Na.) City Zip Code
.e�,,, / 4 (�w.ee ��,c L<.> �i ' � �-o � �� �� � �x
Sedion No. Township Name or No. Ra e No. Fire No. ounty
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PowerSupp'r
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Eledrical Coniracior (Company Name)
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Mailing Address (Conirador or Owner Performing Install<
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Authoriz�l $ignature (ConTractor or Owr� Performir�g In:
6/95 STATE
Phone No.
5 7/'%.�2�0
a,ad�es�
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Con}rador License No. Master Lic. No.
On) �. �, Phone No.
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SEE INSTRUCTIONS bN BACK OF YELLOW COPY