2149 Cliff Rd - Electrical Permitsqm? 0^ ?
3O_+
? OFFIC USE ONLV This raquesi void 18 monllis irom walidanon dole prinred in thi
s b?ryay?
,oo j9? Y 5
PlEASE PRINT OR TVPE
Reqoezt Da Raogh-in impedion reqmred2 [3 Yes Inspedion Other Than Rwghln: 0 Ready Now 0 Will Call
D (Vou must mll ffie inspetlor when ready) DaM Reody
I, licensed coMmtlor owner hereby requesf inspecYion of ihe a6ove electrital work at
J Ad ress (Sheet, Bax ar Root No ???? Gry Z. Cade
Sedion No Township Name ar N. Range No Rre No C ?
o ?J??T
O o nr Phone No
Address
Paw r$uppl.e.
?T ?L..?.i? ???
l./1/l i?..'
Ele I Conlra (C pany Nome Cantranon coense No Masrer L¢ N. (Planr Elect Onlyl
i?
MmLng Address lConv tlor or Owner Pebormi g In mllotmn)
P. - &671_ /J?? ll? Ss' St?
Amhonve Sig mm(Con cbrorOwnerPe allahon) Phons ?N2i.
EB- 5 ST EBO 3EE IMnRUC7ION50NBACKOFYELLOWCOPY '
REQUEST FOR ELECTRICAL INSPECTION
I?? ?I II I III I I I I II II I II I? ?111111 Minnesota A Bvoear Rm . S-1 B Electricity
g21 7nive St Paul, MN 55104 fV
* 0 3 0 4 7 0 9 9 ? Phone (612) 642-OS00 lp%'(p
Home Duple: Ap} Bldg. Otner IJew Addn
Commercial Indushial Farm Remod Re air
Av Cond. Htg. Equip. Wafer Hir. Load Mgm} Ofher.
Dryer Ran e Elec. Heo} Temp. Service
"X" above the work covfe ?d by fhis requesi. Enter remarks ?in ?th]is spoce and an ihe back.of the whife copy only.
7\ec / ??3?Q?-((TS TU
?. '
? /?? ? ???
Colculafe Inspecfion Fe This Inspechon Reques} will nof be accepfed wdhouf fhe correct {ee:
Olher Fee B $ervice Enhance Size Fee # Circuih/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Sheet Lfg./Tmffic Sig Above 200 Amps Above 100 Amps
Tronsformar/Generafor INSPECTOR'SUSEONLV --' TO L
Sign/Oudine Ltg. Xfmc
Alarcn/Remote Conirol
Swimming Pool i hereb cem fiat I f dncal insmllotion descn6cd herem on the doles sbled
Irrigahon Boom ko,roin r°re
h
S
ll ,
nspec
on
pe<ia l ?'re
TH Inves}igatrve Fea
IS INSTALIATION MAY Fina
BE ORDERED UIS ONN IF NOT COMPLETED WITHI 18 M HS. i
id
is rFquest w
months imm 55599 i2s ' I
?9 1
?
`
?.
i 0" 9 '
?.u
. v
,'ue t Date
T /'?
o t{ o a ?? Fire Rough-ii Insper.no?
Req red?
Yes ? No Ready Now
? WiII Notrtv Inspeo-
Ior When Ready
t
Licensed ElectncTl C(nVacto - 1 hereby raquxst inspecUOn oi pbove
ner
Ow
'
electncal work installed et
.a.,r ndd-S?. 8ax or Rouce No._, ? Crty? ?
o.
N o.
Z? YY [•`-
Power SuPPher Address ? .
)/9C ?L"-_.?1CG
F t ? a? ? Conttactor's Lmense No.
Electncal o[racmr iCoinpany Name) : .
°
CC -
. //?,
f/)
Ma,ling Address (COntrec[or or Owner Makine Instailan?onj)
:ti!!J I,L? 1 //l
-? •? -) ?S l1?it 4!r<. LJ ?
AUthonzed 5 nature o actor?Owner MakIny I tallation) Phone NJmber
o ?z? It'n ?- 7
THIS INSPECTION NEQUEST WILL NOT
MINNESOTA STATE BOARD OF ELECTRICITY gE ACCEPTED BV THE STA7E aOAflD
Grig9s-Midway Bldg- - Aoom N•791 UNLESS PHOPEH INSPECTION FEE IS
7821 UniversilV Ave.. 5t Peul, MN 55104 ENCLOSED.
Phone (6121 29].2111
REQUEST FOR ELECTRICAL INSPECTION Ee-00001 -OA
? See instrvctions tar completing this form on back at Yellow copy. 0U.6 )G4r
? "X" Below Wo^k Covered by This Request "rj (1S
Add
R.P.
Type ot Bwltling Applmncas Wired Equiumen[ Wired
Hame
Ranye 7emp0r2Yy $EfViCB
Duplex
Water Heater
Lightiny Fixtwes
H
Apt. Bwlding Dryer eavn
Electric
loader
S
l
U
Cominercial Bldg. fumace i
o
n
{nd?istrial Bldg. Air Condiuoner Bulk M, Ik Tank
Other ISpeciryl
Farm Othai Soec?fy
t er Sp?':ifv
Other
,???
on
o mpute Ins pection Fee Be/ow
M
Fee
ServmeEn<ranceSize q
Fee FeeAels/Subieeders c ts
N Fee
0 to 200 Am s 0 io 30 Am )s %Oc%, 411M, 0 to 30 Am s
100
'
31
Above 200 qmps p,tyy 31 m 100 Amps < io
A
,
n Pool
i
S t„b Above 100-Amps ?'
O
?
e
'
mmi
w ? ? pdr
Ot
her Fee
ta
l.
Trensiormers ?s
Irngation Boon , ?
Signs Special Inspection TOTAL FEE1
?
Remarks ?
Dnte th
Electncal
Rough-in Q /
/ ? ,
e
Inspeclor, hrqb
? cervfy thai the above
! •
Pinal
y/y?/ ?
o`?Py?/?
??'(
inspactimn has been
maAe.
ueatvoiC/BmonMsfwm f/G? f?ra -r
This reQ
REQUEST FOR ELECTRICAL WSPECTION
? Sae me;ructions fc completlng Nis form on back ol yellow coPY E9-00001-07
y?" ..J?Yy
C°
?0 4 `X" Below Work Covered by Thls Request V?
ew Atlde, " - r.,.._ _. ?... . .
Compute lnspection Fee Befow.# Other
Fee
FumaCe - y)
Air Candihoner
acror's Remarks,%
ServiceEnlranCeS¢¢ pee #
Qrcwts/Feeders Fee
0 1a 200 Amps 0 to 100 A
A6ove 200 _ Amps Ab
:tor's use Only Amps
Specia? Inspechon
Alarm/COmmunicaUOn THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT
Other Fee COMPLETED WITHIN 18 MONTHS.
I. the Electrical Inspector, hereby Rou9n-,r,
cer6fy that the above mspecnon has oaie
been made
IFFICE IISE ONLY
his reques[ vaitl 16 monips trom '
I _ /.
?0 7:'S 0 4f n
Request pate
..7 J_
Fre No Rough-in pection
Reqwred
G Yes ? Nu
kReatly Now C?,?,j,3C1
? Will Notdy Inspecror
When Reatly,
I 4censed contractor ? owner hereby request inspection of above electncal work aT
Job Atl ess (Street, o r Route Na ) l) G"y
` Lf
Wn No Townsh,p Na or No gg o CoZ ZW?::
Oocupam (PRINT)
?
PowerSupp r
Atltlress Ph
k5`3
Elec ri al GoMr r(COmpa me) Gontrootorb Lioense No
M i tltlress (Convaeme or Ow Makmq stallahon?
' • ?.3
A??nd"r i aitire ( n racNO'Owner ng In Ila on)
. ?`S3f?
Phone Number
? olLO
rnmNE50TA STATE B60.AD OF ELECTRICITY vIP, THIS INSPECTION REpUEST WILL NOT
Grlggs-MiOway BI(Iq - Room &113 BE ACCEPTEO 9V THE STATE BOARD
1821 Univenlry pve., St Peul, MN 5510C LINLESS PROPER WSPECTION fEE IS
Phona (612) 642-0800 ENCLOSED
I II I? II II I I II? II y II II II III G7 II II III I IIII Mg21 QUm,v sState ity Ave., dRm. SR 28cS ! Pa PI, M`N 5 05104
?K U 2 7 3 3 2 3 6* Phone (812) 642-0800
Home Duplex Apt. Bidg.' Other. New Addn
emod Re air
Commernal Induskial Farm
Air Cond. Htg. Equip. Water Hir Load Mgmt. Other:
Dryer Ran e Elec. Heat Temp. Service
s m this space and an the back af the whife copy only.
ark
f
E
"X" a6we fhe work rovered by th er rem
a requesf.
n
y-S P
Calculafe Inspecnan Fee - iha In spechon Request will not be otcepied wdhoui ihe comecf fee:
Fee
piher Fee M Servirx Enhance Sae Fee # Circvih/Feeders
Mo6ile Home Pork Sfall 0 fo 200 Amps 0 to 0 Amps
Sireef Ltg./Tmffm Sig. Above 200_Amps Above 00_Amps
Trans{ormer/Cienerabr INSPECTOP'SUSE ONLY ('1? j T
Sign/Outline Lig. XSmr.
Alarm/Remofe Control
$Wi0lming Pool I he I i s the ebdncal mslo on desrnbed hemm an the dak nakd
Irrig6fion Boom R -ir, DO1 -
Special Inspettion F o? D.
Investigative Fee .... . o ? no ncocn rnc(:oNNECTED IF NOT COMPIETED WITHIN 18 MONTMS.
iTnia main?v.nvi. m... ..? ?
r
2 6? 3? J 4 ?
PLEA 9FFFIIINT OR TYPE OFFi E USE NLY Thrs requnr wid 18 monlhs lrom voLdobon dme prmed in Mis bax
a3 f9?
Requesl Ll
r Rough-in inspecnan required2 QV
(You musl mll the urspeqor whan ready? Inspecnon Oiher Thon Rough-In 0 Raody Naw ill Call
Oam Ready
I, licensed mnt cfor ? owner here6y requesf inspedion of the above eledriml work of:
Job? s ?Sfrcet, 8ox, or Rou1e4
f / Gty ? Zip Code
??/`,.
Sernon No Tewnship Nome or No Ronge N. Fire N. Counly
/
?
Occuponl A
/G. Phane No
Power Supplier dress
ElennmlFoAti 5?omoa?? ryo?
L!A 6
, ??.f Commdor se N. MasKr Lc N. (PIan1 Eletl Only)
Mading Addr? Canhonar ar Owner Perlorming InslalloLOn)
AuMonzed re(Confronw wnarPehormmglnsmlloeooJ PhoneNo
10 N95'_? ?SYATEB07'RUCOPY-SEETF?TpUCT10N50NBACKOFYELLOWCOPY
[
a
I?? I I? II I I1 II tI II II I I?II? ?? REDUEST FOR ELECTRICAL INSPECTION ? ?
?.?
Minnesota State Board of Electricity
1821 Universiry Ave., Hm?SB«
, $t/Paul, MN 55?04??? 0 2 6 3 3 Q 4 8* Phone (612) 642-0800 ?j j? y, ?:?
ome Duplex Apt. Bldg Ot-?- w Addn
Commerciol Indushial Form Remod Re air
Air Cand. Hig. Equip. Water Hic Lood Mgmt. Other:
Dryer Ran e Elec Heat Tem . Service
"X" above the work covered by this request Enfer remarks in this space and on }he 6ock o( ihe whife copy only.
Calculofe Inspxfion Fee - 7his Inspection Request wJl nof be a<cepted without the <orrect fee:
Olher Fee A` $ervice EMrarce Size Fee # Ciraih/Feeders Fee
Mobde Home Park Stoll 0 to 200 Amps 0 to 100 Amps '
$freel Ltg./TraHic Sig. Above 200 Amps Above 100 Amps
Transformer/Genera}or y
\ TOTAL
Sign/Outline Lfg. X{mr. ?
y
Alorm/Remote Conhol =
Swimming Pool descn6ed herem on the dmes smied
almnstl.t-
Irrigafion Boom kough-in Daee
ecial Ins
S
edion
p
p F
l D
Inves}igofive Fee inw
THIS INSTALLATION MAY BE ORUERED DISCO C IOT QOMPLETED WITHIN MON .
?--
2 3 9° 013 RI [(J O/7 C? YThu, request.oid 18 manrhs !mm vahdanon dore pnnted n ihis bry?
7 > ?Sa
PLEASE PRI
T
NT OR
YPE
ReQOesf ?are Rough-in inspen?on reqmred2 {?Yez Inspecl?on OlherThan Raogh-In p Ready Naw 0 Will Coll
(You must mll the inspedor when ready) Dak Ready
I, ? licensed mn}racfor Q owner hereby request mspedion of }he above eledncal work a}
Job Address (Sireef, Box, ar koute No ) Cip Zip Code
r s???_'?.
Sechon No Tawnehip Name or No Range N. Fire N. Counry
Oaopam
? Phone No
Power5opp6erQ' ` Address
Eledrim) Canvanor (Company Nomel Commcmr Lcense No Masrer bc N. (Plam Elev. Only)
J
Mmling Addreaa (Commnor oi Owner Pedorming Insbllonon)
)S?7a 45''? ?. , = P.:? --, Yn?1? 5_? -'3 7
Aulhonud SignaW.e IContmdor or Owner PeAorming InzmllaM1an) Phane No.
EBOOWIA-106/95 STATEBOAHDCDPV-SEEM5THUMIONSONBACKOFYELLOWWPY
TION Xt? ?
REal1EST FOR ELECTRICAL INSPEC
?
??
?IIIIII ? IIIIIII?I
?
`
Minnesota State 8oard of Electriciry
?
?
1821 Univefsity Ave., Rm. 5-1 8, St Paul, MN 55104 ?
s 0 2 3 9 0 1 3 6* Phone (si z) 642-0800
Home Duplex New Addn
Apt. Bldg. Other: Remod Re av
Commerciol Industrial Form
Air Cond. Hfg. Equip. Water Htr. Load Mgmt. Ofher:
D er Ran e Elec. Heot Temp. Service
maiks m fhis tpace and on the bock of the whife copy anly.
t
t E
"X" above the work covered by }his re er re
n
ques
ci?? JI?.?J? 1?n`-`1}t S ?wy
{?,?
4
Colculate Inspechon Fee - This Inspechon Request wJl nof be accepfed withovh fhe correct fee
pRher Fee # Service Enhnnce Size Fee # Circuits/Feeders Fee
Mobile Home Park 5}all
' 0 to 100 Amps ,3. "'
0 ta 200 Amps
Sireet Ltg./Traff ic $ig. Above 200_Amps 100_Amps
Tmnsformer/Generafor INSPECTON'SUSEONU' JOTAL r G
Sign/Oufline Lig. Xfmr.
Alarm/Remote Cantrol
Swimming Pool I hereb <eni that I ins ecred 1 I ms I e dotes s?m
DO?
I[rigafion Boom Rough-In
r
Speaal Inspedion F al
Inves}igatrve Fee
.
. o. nn
ncocn niecnuNFCTED IF NOT COMPLETEO WITHIN 18 MONTHS.
.....,?..__.
I mIs maiALu.i iwn P..... .,l-
2 3 5 m 412 ? OFFI E USE ONLY This reqoesl void 18 months!mm .alidaoon date pnnled in this 6ox
4ra.?05
?
?I
?
PLEASE PRINT OR TYPE .
.
?/?/
Requead Date Rough-?n mspecl?on reqmmd2 Yes ? No I?sp<rnon 01herThon Rough.ln ? Reody Now Will Call
( I a Ci ? (You mus? wll Ihe i?apeeo? when rwdy) Wfe Ready
licensed contracror owner hereby requesf inspedion of the above eledncal work of
Jab Pddress (Slreet, Bax, ar R.O. Na ) Gry
c Zip Code
2itiC'A c,L_, Ze,t. a «n
Sedion N. iownehip Nome or No Ronge No Fme N. Coon/ry'?Q
Ompon? / /?
GRr?.uDc1 (?J?eP Phane N.
Power Supplier Pddress
Elednmi Contmdor IComvony Nam Conrcador Uanse Na Mmmn c? No (Plam EIM Only)
?r'1 Glcr lec.f2.'L (AO ICn?6(v
MaAmg Aildresa lConhocmr ar Ownar Pedorming Insmlloton)
/iz /'d' Sr l-,vui`s PAi2rc
AoMonzed 5 m(Comratlor Performng sbllationl Phone No
/?
?CaG ?E'Y
EB- -1 6/95 STATE COPY•SEEINSTpUCT10N3ONBACKOFYELLOWCOPY
REQUEST FOR ELECTRICAL INSPECTION ? e ???5
821 iry Av . Paul, MN 10 F??
I II III IICt7IftEl ar Rm f SI128' St
* 0 2 3 5 4 1 2 4? Phone (612) 642-0e00 ome Duplex Apt. Bldg. Other New Addn
Commercial Indusfrial Form Remod Re air
Air Cond. Hfg. Equip. Water H}r_ Load Mgmt Ofher.
D er Ran e Elec Heaf Tem . Service
above fhe work mvered by fhis request Enter remarks m this space and on }he back of the white wpy onfy.
Gl? ?
Calculafe Inspechon Fee - 7his Inspechon Request will not be accepted wifhout the correct fee.
OH?er Fee # $em?x EMroce Size
n Fee # Circvih/Feeders Fee
Mo6ile Hame Park Stall 0 fo 200 Amp
s 0 to 100 Amps
Streef L}g./TraHic Sig. Above 200 Amps Above_j(10 Amps
'
TransformedGenemror INSVECroa'SUSeoNLY TOTAL
Sign/OutLne Lig. Xfmc
Alarm/Remote Confrol
Swimmrng Pool I hereb «tli ?hat I ins the elMnwl insmllanon descnbed herenn on tha daks smkd
Irrigation Boom pa„yh.in
7 oak ? /:
Y
l
S
e<iallns
ection ZrS
? Z
p
p
Invesfigo}ive fee
Final
?
Do
34
ONT S.
THIS INSTALLATION MAV BE ORDERED DISCONNEC7W41_5NOF9F W 1?HI 7
/
1
I
n?1 ? R Q/'? A ?
{ OFfl E U E ONLY ihis request roid I B mon1hs (rom validohan dore pnNed in ?his bo?
.51 7:rt G
PLEASE PRINT OR TYPE 41 p? ? O?
Req.est Doro Roogh-in mspenian reqmredY ? Yes No Imped?on Other Thon Rough-In. ? Ready Na. ill Gall
(VoomuslmllMemspMOrwhenreadY) Dat<Ready:
I, icensed canfmdor ? owner here6y request inspedion of 1Fie above eledriml work at:
s ?Slrpeet, Box, Rou No )
a 1 1 ? k t G? /
Lp Code
Senion No, iownshic Name,eAJ o_ Range No- Frre N. 'V??
Oavpanl ?
Phone No
r5vpplie? ? Address
Ele I Conlmnor ? ompany No Cantmcbr Lttm
e No. Masrcr Lc No (Planf Elect Only)
n
? ?
Mai
kfft
Pddress? tmtlororO,.nerPeAormin9lnsmllonon)
onzedSi reIC nhu r rOwnerPedoemi mllo ? PhoneNo
^ [?
_-yj--.-.--.? //..w.co..nvco?rysp[ins?xULTIONSONBACKOFYELLOWCOPY
/
IIIIIIIIIIIIIIIIII I II REQUEST FOR ELECTRICAL INSPECTION
II III'I Minne
? 2 5 sota State Boartl of Electricity
U 1821 Universiry Ave
R
8 6 8
Ho .,
m. -1 8, St. Paul, MN 55104
9 s
Phone (612) gq2-0gpp
me uPlex
Commercial y
P?Bldy, Q?er:
Industriol
Air Cond Nig Equi Form New Addn
W
p.
D er
Ran e ofer lifc
Re oir
Lood Mgmf. Other: Remod
Elec. Heof Tem . Service
"X"I above the work covered by this requesG jENer remorks in tfi
Is oce ond on t e bock f the whd mpy only
Colculo)e !nsPecfron Fee - ? ` L VV4
This lnspeUi
R
ONier Fee
M on
equest wi11 not be occ ted wdboW lhe mmetl fee
# $errice E
?O? S
obile Home Pork $toll
? ?re F? ? Cirni
Fee
t0 200 qm
s
treet ?t
g./iraffic Sig
. p
0 fo 100
Amps
Above 200
ironsformer/Gener
afor
Sign/Outline L}g
Xfmr mps ?700
INSPECTOR•SUSEONLV A?'Ps
'
.
.
Alorm/Remote Control ?pT?`
?? ??
So
Swimmino Pocl
vesrigofiveFee -??1F?^a?
INS7ALLqTION MAY BE ORDERED
WITHIN 18 MON7FiS.
22 ?_ 8 6 g 0 OFF E U E ONLY Thn rcqoest void 18 monthz imm vahdaoon date pnnred in ihis? x
PLEASE PRINT OR TYPE ?
Request Dok Roogh-m mspx?ion required2 ? Yes No Inxpeclion Olher Than Rouqh-In 0 Raody Now ill Call
(Yoo musi mll the mspenor when ready) Dore Reody
I, dor ? owner here6y reques} inspedion o( fhe above elechical work at:
06 Md as (Sheet, Box R le No )
a1?Eq Gry Zp Code
Se No Township e or No kange Na Fim No ?nh
O
OccuPan? PhoneNa ?^7 t['"1
? [ t7?•
?j
If? p
?C_
Pddreas
EI I Connacla (Company N ? Conhanor Lcenu No-
? 2 tr?? Master Lc No (Plont Elxt Only)
Mm6 dress ( dor or Owner PeAarminq Insta1laM1Onl
' `
AuNwnxed aNre (Conlractor or Owriar F leul lanon) Ph?^ f'?_` ^
1A-10 6/9 STATEBO PY-SEEINS CTIONSONBACKOFYELLOWCOPV
IIII II 1?II IIII REQUEST FOR ELECTRICAL INSPECTION x=""'??
Minnesota State Board of Electricity
?f 1821 University Ave., Rm. S- 28 St. Paul, MN 55104 ? ,
* 0 2 2 5 8 6691 7? Phone (612) 842-0800 ?""
Home Dup ex Apt. Bldg. Other: New Addn
Commercial Indusirial Farm Remod Re air
Air Cond. H}g. Equip Water Hfr. Load Mgmt. Orher:
D er Ron e Elec. Heaf Tem . Sernce
"X" obove the work covered by fhrs request Enter remarks m this ace, and o the k of fhe w"te copy only.
--
Calculafe Inspechon Fee - Thrs Inspecfio?n`R q esf wili not be occepfed w,tho the torrect feea`",
Olher Fee #t $ervice Enlrance $rze Fee # Circuils/F Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Sireef Ltg./Troffic Sig. A6ove 200 Amps Above 100 Amps
Transfarmer/Generafor INSPECTOH'SUSEDNLY TO-
TA
L
-
Sign/Oufline Lig. Xfmr. y
?
q
-ay S110
cf
Alarm/Remote Confrol
Swimming Poal I hereb cem ?ho? I ms eaed ?he elecmml ?mmllanon dexrnhed heran on Mit, dabs smred
Irrigafion Boom Roughln f? Dme
$pecial Inspection "
Invesfigafive Fee Final Dote j ? f ?
/
THIS INS7ALLATION MAY BE ORDERED DISCO I WITHIN 18 MONTHS.
2/? C o O? O ?
C J O OFF{CE E ONLY Thrs request void 18 monMs irom vaLdnnon dale pnmed in IF?
&j JQ
PLEASE PRINT OR TYPE
4
e
Requasf Dah 0.wi inspedion reqmred2 ? Yex N. Inspedion Othar Than Raaghln Q Ready Now ill Call
(You must mll the inspenor whe n ready) Dare Rmdy
I, ire dor ? owner hereby request inspedion of }he above electnml work af
reu(Skeet,?arRo No)
I GI Gry ZipCode
rnon No Townehip N or N. Ronge N. Frc No rN
O«uPOnt
II PhoneNo
Y
I
V 4A
suoai:!?
\1, ndd,e..
F I anvoclor (C pony ame) Conhodor Lttnse No
?O
? Masror Lc N. (Plant Eleci Only)
c. 9
Mdraes ntmdor or Owner PeAorming Insloilanan P
Ma
/
ffionx Sig rei on MrorC. n9 Ilauo-) PhoneNo
L
EB- A-10 6195 STATE COPY-SEEINSTRUCTONSONBACKOFYELLOWCOPY
REQUEST FOR ELECTRICAL INSPECTION innesota IIII IIII III ?I III IIIII IIIII 1A821 Univessity AvearRrof EI12 ,cSt. Paul, MN 55104 i`
% ?"'r-. _.;
2 2 5 8 7 ,5 a Phone (812) 642-0800
ew
N
Addn
Home up ex ?
G?
?
Z d i
R
Commeraal Indusirial Farm •'
-
p?
?
'? Remo e a
r
Air Cond. Hfg. Equip. Water Hta Load Mgmt. Other
Dryer Ran e Elec. Heaf Tem . Service
"liv hi space a d an t bock of t white rop_y anly.
'k' above fhe work covered by this reque t Enter remarks m t
_0--es°-?sz.' -? ?
?l ^???
rMO ?
Calculate Inspechon Fee - 7his Inspechon Request will not be ocwpted wd ut the mrrect fe U
lier Fee 3R Service Emrance $"rze Fee # rcui
e Park Stall 0 to 200Amps 0 to 100 Amps
aHic $ig.
r/Genera}or
W Above 200 ?/o?oqmps Abave 100,_Amps
INSPECTOR'SUSEONLY TOTAL
(
e Ltg. X
mr
te Controi
ool
l I nere um thar i aa eued Ihe elei oiiahaa n ed hercin on me dakz:ared
Irzigahon Boom Rough.ln r pok
$pecial Inspedion F al po»r_ _ ?
r? Inves}igative Fee
?e wcrw? ? n"nu ue • ' . /
v RF nGI]ERED DISCONNECTED IF NOT COMPLETED WITHIN iB/MONTHS.