P - 84252- I�I �I �I II III II III I) III (I III II III (I (II II III I III) 821�UEa S ity Ave., REm. S-�1c8ASt.l PaulP, MNT55O104 �� ��
* 0 3 3 6 8 0 0 8* Pnona �si2� sa2-osoo �'��'��"'�
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remo 'Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Ran e Elec. Heat Temp. Service
"k' above the work covered by this request. Enter remarks in this space ond on the back of the white copy only.
L✓lRe ReP�4cer�-�ea'T Bo/���2.
Colculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Olher Fee # Service Entrance $ize Fee # Circuits/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 TOTAL �p
Sign/Outline Ltg. Xfmr. l��
Alarm/Remote Control
Swimming Pool
I hereb cerfi thaf I ins ecied the eledrical installation described herein on }he dates sMted
Irrigdtion Boo �. Rough-In Date
$peciallnspedion � �_
Final �. e .�/ ` �i
Investigative Fee r
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
3^/� _� 0 O � OFFICE USE ONLY This request void 18 moMhs from validation date printed in this box.
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PLEASE PRINT OR TYPE
Request Date Rough-in inspecfion required$ � Yes � No Inspedion Ofher Than Rough-In: �''Ready Now � Will Call
�••� �97 (You must call ihe inspedor when ready) Date Ready: !�! a r 97
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (StreeT, Box, or Route No.) City Zip Code
Y8 - Ta /m ad e w,4 Fv,cQ/c
$edion No. Township Nome or No. . Range No. Fire No. County
Occupanf Phone No.
Power Supplier Address
�—
Elecfrical ConNocfor (Company Name) Contrador License No. Maskr Lic. No. (Plont Elect. Only)
�2T�S Fc,EGTi2iC L°Ao/y8s
Mailing Address (Contrador yor Owner Performing Installafion)
O %i2U i2.s�% =n !/e /C w .7i1 M� /N . � h . s�� /�
Authorized Signature (Confracfor or Owner Performing Installation) � Phone No.
� � ' y/ • �.0
EB-OOOOlA-10 6/95 ST BO COPY- SEE INSTRUCTIONS ON BACK OF YELLOW COPY