P - 83146" I�I� ��� II III II (II II �il II �I� �� I�I (I I�� �� ��I I I��I gEQU E essaO Ae. Rm� S-�1c 8ASt.l PauP M`N 550104 �������:;
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Phone (612) 642-0800 °'�'�
ome Duplex Apt. Bldg. Other: New Addn .
Commercial Industrial Farm Remod air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. OTher:
D er Ran 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.
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Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Olher Fee � Service EMrance $ae 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'SUSEON�Y TOTA��S�
$ign/Outline Ltg. Xfmr. �
Alarm/Remote Control
Swimming Pool
I hereb ceAi that I ins ed ihe elechiml installation described heroin on the dates siated
(rrigdtion Boom Rough.in Dafe
Special Inspect'
� Final Date
Investigative Fee �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS. _
310 - 4 71 OFFICE U$E ONLY Tfiiz requesf void 18 months from validation date prinfed in this box.
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PLEASE PRINT OR TYPE
Request Date Rough•in inspeciion required2 � Yes nspecfion Other Than Rough-In: [�„@rady Now � Will Call
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—� � � (You must call the inspedor when ready) Date Ready:
I, icensed contractor ❑ owner hereby request inspecFion of the above elecFrical work at:
Job Address (Sireet, Box, or Rou No.) Ciy � Zip Code
s�°? /.TO /l �,�J L.�t
Section No. Township Name or No. Range No. Fire No. � ounfy
�A/dGC�-
OttupaM
� � � ` � O � �t/ Phone No.
I EI� 'col Contrector (C
1 ��
or Owner P�
EB-OOOOlAC-10 6/95
Contraclor Lice�se No. Master Lic. No. (Plant
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ing Installofion) i� _A � . �
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COPY- SEE INSTRUCTIONSON BACKOF YELLOW COPY