P - 84261I IIII �II� I� III II III II III I� III II III I) III �I III I III) gE�U� eSsaOAve. Rm� S-f�i BASt.' PauP MNT55�104 ��V�
* 0 2 q 9 � 4 9 L* Phone (612) 642-0800 � � ��`�"'"�
Home Duplex Apt. Bidg. Other: New ddn
Commercial Industriai 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 requesf. Enter remar in this space and on the back of the white copy
� 12�Y7i i �t(��.��� �
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Olher Fee # $ervice Enironce Sae Fee # Circuits
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Ai
Street Ltg./Traffic Sig. Above 200 Amps Above 100
Transformer/Cienerator INSPECTOR'SUSEONLY
Sign/Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
Fee
TOTA�S UQ
I hereb certi that I ins eded fhe elechical installation destribed herein on ihe dates stafed
Irrigation Boom Rough-In Dafe
Speciallnspectio �'�
� :.:_ Final . Date% /� � /
Investigative Fee � 6 �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
2 9 9- 3 4 9 OFFICE USE ONLY This request void 18 months from validation date printed in this boz.
� /S..r�� • a��, _L
PLEASE PRINT OR TYPE
Request Date Rough-in inspection required2 � Yes � No Inspection Other Than Rough-In: � Ready Now � Will Call
d�/�� � (You must call ihe inspedor when reody) Date Ready:
I, icensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sireet, Box, or Route No.) Ciy Zip Code
� � � `7 � 2,� � L, �" �3�
Sedion No. Township Name or No. Range No. Fire No. Counly �
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Power Supplier � /, .:-1
,
�7 /c' /L)r�i � `S
dress (Con}rador or Owner I
��c ; �_ a �
Signature (Confrador or Owner Performing Installafio� �^� P
e
V � -�.�.
STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY
�I
Phone No.
L.s 1�,� .�r �isrv,v
Confrador License No. Master Lic. No. (Plant Eled. Only)
EB-OOOOlA-10 6/95
SS c
one No.