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P - 82680( I�I I) III !1 II� II III II (II II II II III II �II (� I�I I(III 82� � Ea SsaOAve. dRm. S-�1c 8ASt.' PauP M`N 5O5 04 �?� .��� l �ty , * 0 2'� 9 3 4 5 9 � Phone (612) 642-0800 ��"�'� Home Duplex Apt. Bldg. Other: New Addn Commercial Industrial Farm Remod Re air Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other: Dryer Ran e Elec. Heat Tem . Service "X" above the work covered by this request. Enter remarks in this space and on the back of the white copy only. �yl� � � � � q � d el � '1 � o V� .� �'�,. � - r Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee: Other Fee � Service Eniranae Sae 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 T�TA� � $ign/Outline Ltg. Xfmr. O � � � � � ' Alarm/Remote Control Swimming Pool I hereb certi that I ins eded the elecfrirnl insMllation described herein on the dales smted Irrigdtion Boom Roogh-In �re Special Inspedion ��+"3 � � � Finol Investigative Fee THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS. 2 9 9- 3 4 5� OFFICE USE ONLY This request void 18 months from validafion dote printed in this box. �/ '� •:�� PLEASE PRINT OR TYPE Re9�� �� Rough-in inspetfion required2 � Yes � No Inspeclion O1her Than Rough-In: � Ready Now � Will Call (You musi wll tha inspeclor when reody) DaTe Ready: I, ❑ licensed contractor � owner hereby request inspection of the above electrical work at: Job Address (Street, Boz, or Route No.) Ciy Zip Code Cso— 6 l��� !�v e i l�i� �� r� c� ,75�{3 Z-- Sedion No. Township Name or No. Ronge No. Firo No. �nty I�rto�a Occupant Phone No. /�-ll �a v� l� C►^� C.[c�U v� SD2- � 2SD Power Supplier Address Elecfiw�ontracror (Company Name) �) /� u:!� ( Conhactor License No. Masfer Lic. No. (Planf Eleci. Only) �^ r l�i� `� f� t� � J Moiling Address (Conhccfor or Owner Performing Insfallation) ( � �� ; � �` j o Aufhorized ( haclor or O� Perf Installafion) Phone No. /- ' �S�'v z--o �S'D EB-OOOOlA-10 6/95 STATE BOARD COPY- SEE INSTRUCTIONS ON BACKOF YELLOW COPY