P - 83768IIIt�III�IIIIII�IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII 8E1�UE eSsaOB a REo S-�1C8AS.IPauIP, MNT5O5 04 ���V�3
�* 0 3 3 4 4 2 2?� Phone (612) 642-0800 ��"�'�
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Re air
Air Con�J� Ht quip. Water Htr. Load Mgmt. Other.
Dryer Ran e Elec. Heat Tem . Service
K" above the work covered by this request. ,Enter remarks in this s ace and on the back f the hije copy only.
y�-eP��c�..��� �c� � ���a� � �"��
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Ofher Fee # $ervice Entrance Size Fee # Circuih/Feeders
Mobile Home Park $tall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic $ig. Above 200 Amps Above 100 Am
Transformer/Generator INSPECTOR'SUSEONLY TOTA
Sign/Outline Ltg. Xfmr.
Alarm/Remote Control
Swimmin Pool
Fee
�5 �
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g I hereb ceAi }hat I ins eded the elecfrical insfallation described herein on the dates stated
Ir�igation Boom Rough-In Date
$pecial Insp i ,
Final �at
Irnestigative ee - ^2-S `
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
3 3 4— 4 2 2 OFFICE USE ONLY This tequesf void 18 monfhs from volidation date printed in ihis box.
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PLEASE PRINT OR TYPE
RequesT Date � Rough-in inspection required2 � Yes �No Inspecfion Other Than Rough-In: � Ready Now ❑ Will Call
...- �� _ (You must mll ihe inspedor when ready) Dafe Ready:
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Jo� Add ess (Afreet, B x, r Route No.) City Zip Code
.j. . R 9 - - - - n ./t 1 �._ r J I r . r .,.,-. . � .,
Sedion No. Township Name or No. Range No. Fire No. Coy/f
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Occ aM � Phone
�
Power Supplier Addre
� � �� CS �02.� �
EI cal Contrador Compan e) Conimctor License No
�r�r�� �.-�r,�, �� � � an , 4r� 51 �
�I � k ' � I
or Owner Performing ItwL
Master lic. No. (Plant Eled. Only)
EB-OOOOlA-10 6/95 �$fATE BOARCT'G�O�Y- SEE INSTF�1Ci5i�ffiQN�/1CK OF YELLOW COPY