P - 83974I I II II ��I II) (I III II I�I II III II II) II II) I) III I I��I gE�Uni eSsaOAve. Rm� S-�ic BASt.I PauP MGN 550104 ��u�e
* 0 2 9 9 4 2 3 4* Phone (612) 642 Pqs � ' � ������°"'�
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ome Duplex Apt. Bldg. Other. �` c� New Addn
Commercial Industrial Farm �`d emod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
D er Ran e Elec. Heat Tem . Service
"X" above fhe work covered by this request. Enter remarks in this space and on the back of the white copy only.
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Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # Service Entrance $ize Fee # Circuiis/Feeders
Mobile Home Park $tall 0 to 200 Amps ;j 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'SUSEONLY TOTA
Sign/Outline Ltg. Xfmr. � �
Alarm/Remote Control
Swimming Pool
I hereb cerli that I ins ecMd the eledrical insfollation described herein on ihe dafes stated
Irrigdtion Boom Rough-In Da
Fee
�
$pecial Inspecfi `—"—'�—
Investigative F F���� —'�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTH
2 9 9- 4 2 3 � OFFICE USE ONLY This request void 18 months from validation date printed in ffiis box.
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PLEASE PRINT OR TYPE `" ' �/
Request Date Rough-in inspedion required2 �Yes � No Inspection OtherThan Rough-In: ❑ Ready Now �Vy
�� (You must call the inspedor when ready) Date Ready:
I, ❑ licensed contractor �owner hereby request inspedion of the above electrical work at:
Job Address (Streef, Box, or RouM No.) Ci� � Zip Code
��;�-���, r, �,� � � ��„��c.�� � �y�a
or No.— � � Range No.
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Power $upplier
Eledrical ont dor ompany Name)
Mailing ddress (Co f dor or Owner Perf
Authorize ignatur (Contmdor or Owner
EB-OOOOlA-10 6/95 S
Call
Phone No.
;C�Q� C) � / — ���
�' ��, �, � �-�-�, � : �.
�Contrador Li ense No. Master Lic. No. lanf Eled. Only)
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INSTRUCTIONS ON BACK OF YELLOW COPY