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