P - 84658IIIII �I� (IIII II III IIIII (IIII (IIII IIIII IIIII IIIII 82�UEa Ss OA a dRm� S-�1 SAS'PauP MNT55�104 ��
� 2�9 9 3 � 5 5 * Phone (612) 642-0800 � �
Home Duplex Apt. Bidg. Other: New Addn
Commercial Indushial Farm Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other: L� c� hf 5 T D 4�' �G {'3
er Ran e Elec. Heat Tem . Service
"k' above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
Calculote Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee #E Service Erdra Sae Fee � Circuih/Feeders Fee
Mobile Home Park Stall 0 00 Amp 0 to 100 Amps
$treet Ltg./Traffic Sig. Abov 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTA
$ign/Outline Lig. Xfmr.
Alarm/Remote Control � � �� �
Swimming Pool
I hereb certi thaf I ins e the elechital insfallofion described herein on the dates stated
Irrigation Boom Rough-In Da
$pecial Inspedion 6
Final
Investigative Fee
THIS INSTALLATION MAY BE ORDERED DISCONNE IF NOT COMPLETED WITHIN 18 MON S.
2 9 9- 3 8 5� OFFlCE USE ONLY This request void 18 months from validafion date printed in this box.
/� �'�
3/°,�D ��3
PLEASE PRINT OR TYPE
Request Date Rough-in inspedion required2 ❑ Yes � No Inspecfion Other Than Rough-In: � Ready Now � Will Call
(You musf call ihe inspedor when ready) Date Ready: -
I, ❑ licensed contracFor owner hereby request inspection of the above electrical work at:
Job Address (Sheat, Boz, or Route No.) City Zip Code
3�.t �q�hwa N�• ���1�� Ssv�z
$eciion No. Township Nome or No. Range No. Fira No. County �
�
Occupan� Phone No.
� aa� s o� � � �8 —dry3 �
Power Sup ier Address
��c � sa-n,� as a 6 o v�
Eleckical Conkoctor (Company Name) Conirador License No. Master Lic. No. (Plont Eled. Only)
Mailing Address (Conhaclor or Owner Performing �nstallation)
3 '�h cv �U. �- ��. �r( ( e /1'1Pli: s-sY � a
Authoriz $ignature (Confrador or Own ing I s ation) Phone No.
�� i 1 �8�! �q3 6
EB- A-10 6/95 STATE BOARD COPY E INSTRUCTIONSON BACK OF YELLOW COPY