P - 83869I IIII31 ��I II III II I!I II III II III II III II III I� I�) I(��I gEQU E eSsaOAve., Rm� S-�ic BASt.1 PaulP, MGN SO5104 ����'
,,� 0 2 � 9 4 1 1 9 * Phone (612) 642-0800 ,, �°�`����
Home Duplex Apt. Bldg. Other: }`-' �lew Addn
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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.
'�SC�'Ylfis;� C� Q `� `'YY� r'C�'V�e��K.� ll�'�-�.
Calculate Inspection Fee - This Inspection Request will nof be accepted without the correct fee:
Ofher Fee # Service EMrance $ize Fee # Circvits/Feeders
Mobile Home Park $tall 0 to 200 Amps to 100 Amps
Street Ltg./Traffic Sig. Above 200 Amps Above 100 Am
Fee
Trans{ormer/Generator INSPECTOR'SUSEONLY TOT
$ign/Outline Ltg. Xfmr. � � S�
Alarm/Remote Control
Swimming Pool
I hereb cerfi that I ins eded ihe electrical installation described herein on the dafes sfafed
(rrigation Boom Rough-In Date
Speciallnspe ""
Final D
Irnestigative Fee
THIS INSTALLATION MAY BE ORDERED DISCON D IF NOT COMPLETED WIT IN 18 MONTHS
2 9 9- 411 OFFICE USE ONLY This request void 18 months from validaTion date printed in ihis box.
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PLEASE PRINT OR TYPE
( �� �'
Request D e Rough-in inspecfion required2 ❑ Yes � No Inspecfion Other Than Rough-In: � Ready Now Will
`O f� �� (You must mll the inspedor when ready) Date Ready:
I, ❑ licensed contractor �[ owner hereby request inspection of the abYve electrical work at:
Job Address (Streef, �, or Route No.) .(� C� � Zip Code ` ,�
ip Name or No.
3a
I � Occupant
Power $upplier
S�
, Eledric6l Conhador (Company Name)
Call
V Range No, � Fire No.V County
a �I fl IC.e�
^ Phone No.
^ 1 c �� /
Address
1M lS !� ��t1n r- l v �s ��
Conirador License No. Master lic. No. (Planf Eled. Only)
' Mailing Addres� onirado�ne�orm-ing Install� J ^'
f�� o( nC alif< i 4''l %�
Signature
P///hone No.
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EB-00001 A-10 6/95 ° STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY