P - 83901I II[�I �I II (II I! �I II III II �II I) III I) !II �� I�I I I�II gE��o eSsaO Bo Rmo S-�ic BASt.' PaulP, MNT5O5104 ������
* 0 2`� 9 4 1 6 8* Phone (6i 2) 642-0800 a��`'�'"'9�
,,
Home Duplex Apt. Bldg. Other. �� �-� Ne Addn
mercial Industrial Farm emod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Ran e Elec. Heat Temp. Service
"X" above the work covered by this request. Enter rema�rks in this space and on th�e ck of the white copy only.
.c-C� �vs �— .�"`I �� /'-�cS s� � � �t'� 'G:�' ,..�
i'//r���✓JGS -� /..�ti 1 ��7�
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # Service Enhance $ize Fee # Circvih/Feeders
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
$treet Ltg./Traffic Sig. Above 200 Amps Above 100 Am
Transformer/Generator INSPECTOR'SUSEONLY ,5 �_ �5- TOTA
$ign/Outline Ltg. Xfmr. f/ �. y, Si,J, �
Alarm/Remote C trol � �
, �}hs
S" P I�`�
Fee
cl SZ%
wimming o0
�� I hereb certi that I ins eded fhe eledrical installation described herein on ihe dates statr.d
Irrigdtion Boom �> , ` Ro„yh-i„ Da+e/ q
Special Inspecf l�^ 2/ g
.. Final �a� ,/ �`
Irnestigative Fee '
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
2 9 9�'Y 1 6 '1� �FF�CE USE ONLY This request void 18 mon}hs from validation date printed in ihis box.
s /1 (
'� �:J S / �
fj 7/�
PLEASE PRINT OR TYPE 1���' ��`'
Request Daie Rough-in inspedion required2 �Yes � No Inspedion Other Than Rough-In:�Ready Now � Will Call
,� �� „� �� (You must call the inspedor when ready) Dafe Ready:
I, [�licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No. City Zip Code
7 � _ -�.�� s� ��// �.� �
Secfion No. Township Name or No. Range No. Fire No. unty
�� �_ � d' �
�Oc 1 % Phone No.
lii'1�t��( "Y' `y �-,.'✓JCY'�i�.�
Power Supplier Ad ess
Eledrical C nirador (Company Name) �� Contractor License No. Master Lic. No. (Plant Eled. Only)
�S` c .cr� �'��i• frdf _1�.-�� �i'�'��3%�—
o�
.� 4. C�sE
Authorize igna ' �Contrador or er Performing ta ion) �
255��
EB-OOOOlA-10 6/95 STATE BOARD COPY- SEE INSTRUCTIONS ON BACKOF
/��' �s.�G,
Phone No.
Y�.s -���