P - 81381l�llIIIIIIilllilll411111141111III illl M82�1 U�nisSstyOAveLRm SR�CB, St �aPEMNION04 �w ��
* 0 3 9 2 4 1 9 8* Pno�e lssz> sa2-oaoo ��'
, Home Duplex Apt. Bldg. Other New Addn
f:nmmercial Inriuctrial Farm Remod ReoaiY
Water Hir. }� Loatl Mgmt. Other
Elec. Heat Temp. Service
requesL Enter remarks in fhis space antl on the back o/ the white copy only.
SAVER'S SWITCH ZNSTALLATION
u�e[e In�ect/on fee - Thls Inspec[ian Request will not be acceptetl without the cwrect tee:
Other Fee +� Service Entrance S'rze Fee � Circuits/Feetler5 Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street LtgJTraffic Sig. Above 200_Amps Above 100_Amps
TransformeNGenerator wsaecloa�s use orv�v TOTA
Sign/Outlirie Lt9� Xfmr. . . �-�0
ovvuununy �wi — ' I herebY certity (hat I Inspeoted Iha electrical uis�ellation tlescribetl hPrein on [hs tlates staleA
�I�19a}IO� BOOfII Rough-In Da[e
X Specia�inspeciion 1�.50 F���ai D:�e
Irnrestigative Fee L �� '
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requeat void 1& monlhs bom valMallon tlate prirtetl in this box.
392-41 �]8 � /s .�
ia�
JOB NUMBER #�0600m
PLEASE PRINT OR TYPE
Request Da�3� � 9� Rougm�n inspection requireCP 0 Yes D�lo Iris➢eopon OIM1er Tnan RougM1-I¢ fi. Ready Now � WIII Cell
lt T
(YOU rtust call tY�.e tr�specior vv�en reatlyj �Z�e Feetly
I, � licensed contractor ❑ Qwner hereby requesf inspection of the abo�oe electncal work at:
Job Address ISheeL 6ox, or Route No.) City Zlp Cotle
04856 2ND 5T NE FRZGLEY 55411
Sed'pn No_ Townshlp Name or No- Rsngz PJO. Fire IJO. Gounry
axc�xn
Occupan[ phone�VO.
4`ARL 0 YOUNGREN 572-8983
Power Supoller Atlaress
Elacincal Contrec[or ((.bmpany Name� Coniracto� Licer�se No.
7
Meiling Adtlress (Coiriractor orbwcerPerfortn)ng Installation)
.? �. -.
Authodzetl SlgnaNre (Con ac�or or Owner Performing Installa�ion)
`��i �
E&00001A-11 Rt55 STATE 80Aft0 COPY -SEE INSTfiUCTI0N5 ON BACK OF YELLOW COPV