P - 83402I�IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII) 1n82�1U�iverstOBeLR� SR1C8 StNaPEMN5O5N04 ������'
, * p 3 7 8 8$�$* Phone (612) 642-0800 '�`'�"'
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat emp. Service
"X" above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
SAVER'S SWITCH INSTALLATION
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator /N�ECTOR'S USE ONLY TOTAL
Alarm/Rem - �'*
Swimming � ry�,�, �.p�y p� �;,� �,�iz�,K,a� ineArldion ds�oril�d �enin on the dates stated
Irrigation Boom Ra,�,-tr, p�s
Special Inspection
Final
Investigative Fee v-/,�°^S�
THIS INSTALLATION MAY BE ORDERED DIS NECTED IF NOT COMrLETED WITHNi 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validation date printed in this box.
378-885�] . �s, S7�
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PLEASE PRINT OR TYPE JOB NUMBER #9706000
Reque 6% 16 / 98 Rough-in inspection required? ❑ Yes ❑ jJo Inspection Other Than Rough-In: [Z Ready Now ❑ Will Call
(You must call the inspector when ready) �S Date Ready: x
� •��9�
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
Section No. � Township Name or No. � Range No. � Fire No. � County
Occupant
Power Supplier � Address
Phone No.
�Elecinca� Contractor (Company Name) ��' `� Co�actor License No. Master Lic. No. (Plant Elect. Only)
M n or St211a '
' natu r o P �� • Phone No.
i�
EB-00001A-11 /95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLO Y �