610 Lantern Ct2 OFFICE USE ONLY This requesf void 18 months from validafion dare pnMed in Niis box.
1 V- 3 8 6 ?
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P SE PRINT OR TYPE
Requnf Dafe
7- 5- 9 6 Rough-in inspeclion requiredY [] Yes N
(You must mll the inapector when ready) Inspecfion Olher Than Rough-In: [] Ready Now Will Call
Date Ready:
I, [M licensed contractor ? owner hereby request inspection of }he a6ove electrical work at:
Jo Veet, Bax, or Route No.) City Zip Code
Lantern Court Eagan 55121
Section No. Towmhip Nome or No. Range No. Fire No. County
Dakota
°y"°Po'f Eagan Phon`N' 681 -431 6
Power $upplier Address
Eledrical Conlmdor (Company Nama)
CoMmcbr Litense No.
MasMr Lic. No. (Plant Elecf. Only)
Gilbert Mechanical I CA02528
Mailing Address (ConlracYOr or Owner Pedorming Installation)
4451 W. 76th St. M ls MN 55435
Authari:edr ' e(Conhador o wner Performing Inztallation)
Phone No.
}?. (? jy? , 835-381 0
EB-060OlA-16 6/95 4?7 STATEBOAfiDCOPY-SEEINSTRUCTION30NBACKOFYELLOWCOPY
IIIIIIIIIII MIIIIIIIIII REQUEST FOR ELECTRICAL INSPECTION,?a
Minnesota State Board of Electricity
1827 University Ave., Rm. Sf/f9 128, St. Paul, MN 55104
* 0 7 5 3 14 61 * Pnsne{si2rsa2-osoo ?&
Home Duplex i Apt. Bldg. Other:
Llft StdtlOR New Addn
Commercial Indushial Form Remod Re air
Air Cond. Htg. Equip. Water Htr. Lood Mgmt. Other:
D er
Ran e
Elec. Heat
Tem . Service S2rV1C2 Panel
"X" a6ove the work covered by this request. Enter remarks in this space ond on the back of the white copy only.
Install lightning Arrestor & surge protecto
on Service Panel at Country Hollow Lift
Station
Calculaie Inspecfion Fee - This Inspection Request will not be accepted without the correct fee:
Olher Fee # $ervice Enfrance Size Fee # Circviis/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 21 0 to 100 Amps F-u •
Street Lig./Traffic $ig. Above 200 Amps bQye 100 Amps
Transformer/Generator INSPECTOq'SUSEONLY TOTAL .
$ign/Outline Ltg. Xfmr.
Alarm/Remote Control
$wimming Pool
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Special Inspedion ?
Investigative Fee Fin ?
THIS INSTALLATION MAY BE O DISCON CT D IF NOT COMPLETED WITHIN 78
MON
THS.