P - 84296I�II� II I� II II� II III II III II II II II) (I III �I II� I I��I gE�Uotv SsaOAve., dRm. S-�1c8ASt.1 PauP M`N 505104
y� 0 2 9 9 � 5 4 1 * Phone (612) 642-OS
Home Duplex Apt. Bldg. Other. �' ��; �� New
Commercial Industrial Farm TI7 %� Remod
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
D er Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on the back of the white copy �
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Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Olher Fee # $ervice Entrance Size Fee # Circuiis/Feeders Fee
Mobile Home Park Stall �C 0 to 0 Amp� 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR�SUSEONLY TOTAL
Sign/Outline Ltg. Xfmr. ° p�.� ��5�
Alarm/Remote Control S�n`� � / ^
Swimming Pool
I hereb ce�ti that I ins eded the eledrical installation described herein on the dofes siated
Irrigation Boom Rough-In - Dofe
$pecial inspe
Final � �:� -
Investigative F �
THIS INSTALLATION MAY B ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
2 9 9- 3 5 4 OFFICE USE ONLY This request void 18 months from volidation date printed in this box.
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PLEASE PRINT OR TYPE �" / �
Requaes Dote Rough-in inspedion required2 � Yes No Inspedion OtherThan Rough-In: � Ready Now ill Call
�� (You must call the inspedor when ready) Date Ready: �
i, ❑ licensed contractor owner hereby request inspection of the above electrical work at:
Job Address �Sireet, Box, or Roufe No.) Ci Zip Code
'��l�`� � rh �i �/c �.-; ��� �S 5=r�
Sedion No. Township Name or No. Range No. Fire No. Counly
3C� � ,��a,E,4
Occupant `� Phone No.
/'1'%i:�e H� r�o n 58�0 -�7 3�7
Power Supplier Address
�s� f°►r10 S 11.7. ' ✓.
Elecfrical Contrador (Company Name) Conirador License No. Master Lic. No. (Plant Eled. Only�
VL/Lj�v �i/
Mailing Address (ConTracfor or Owner Performing Installafion)
ygnanre ��,o o ertorrtyMG Instollation) • n Phone No.
/� �_"'s�s��o� � ' �� A �fj � ✓ sJ �
10 6/95 STATE BOARD COPY- SEE INSTRUCTIONS ON BACKOF YELLOW COPY