P - 83874I I�� I�II II III II III II lil II !I� II III II III II �II I I��I g21�U E essi OAve. Rm� SR c BASt.' PauP MNT55�104 ��`ry�
�� 2 9 9 4 1 3 5* Phone (si 2) srya2-oa ' � � "�'� �
Home Duplex Apt. Bldg. Other: , �-A New Addn
Commerciai Industrial Farm S� '�'� emod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Ran e Elec. Heat Tem . Service
"k' above the work covered by this request. Enter remarks in this space and on fhe back of the white copy only.
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Ofher Fee # Service E $ize Fee # Circuits/Feeders
Mobile Home Park $tall to 200 A dl7 ,$� 0 to 100 Amps
Street Ltg./Traffic $ig. Above 20 Amps Above 100 Am
Fee
Transformer/Generator INSPECTOR'sUSEONLY TOTAL�j —7�
Sign/Outline Ltg. Xfmr. o��-sv
Alarm/Remote Control
$wimming Pool
I hereb ce�ti that�l ins ected the eledrical insfallation described herein on fhe dates stated
Irrigdtion Boom Rough-In D
Special Ins i'� C ' � — ��
Final � � � Date
Investigative ee -C �- -- �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
2 9 9— 413 OFFICE USE ONLY This request void 18 monfhs from validation date pnnted in this box.
O?(�f � o ����
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PLEASE PRINT OR TYPE
Request Date Rough-in inspecfion required2 ❑ Yes � No Inspedion Other Than Rough-In: � Ready Now � Will Call
/Q °�%% � (You must mll the inspedor when ready) Date Ready:
r
I, ❑ licensed contractor owner hereby request inspection of the above electrical work at:
Job Addre s(Sireef, Box, or Rouf o.) Ci1y Zip Code
o�� 7E.J ��Q Q .5 S, joZ
Sedion No. Township Name or N. Range No. Fire No. County
- - �n vz y orl�
/-��} �c� L �
Power$upplier �� ^
% '
ElecFriml Conhaylar�Company Name)
Mailing Add?ess(�o
Authorized Signature
EB-OOOOlA-10 6/95
Phone No.
�/�' �/ /1
f�LS �2.�-� Di �
Contractor License No. Masfer Lic. No.
or Owner Perfortning Installafion)
�
�ot Owner Perf ing Installationy . B f' � t- r l P
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STATE BOARD COPY- SEE INSTRUCTIONS ON BACKOF YELLOW COPY
No.
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