P - 83839� I�II II I� II �I I1 i!I II III II III I) III II (II II ��� ( I��I sE�Uota SsatOe B a dRm. 8-1c 8ASt.) PauP MNT55�! 04 ��
* 0 2� 9 4 � 7 7* Phone (612) 642-0800 �`"�'�
Home Duplex Apt. Bldg. Other. New Addn
Commercial Industrial Farm Remod ^� Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
"X" above
Elec. Heat Tem . $ervice
this request. Enter remarks in this space and on the back of the white copy
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # $ervice Entrance $ize Fee # Circuits/Feeders Fee
Mobile Home Park Stall to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Amps Above 100 Amps
Trans{ormer/Generator INSPECTOR'SUSEO v ry TOTAL
$ign/Outline Ltg. Xfmr. � � � � V �' �
Alarm/Remote Control
Swimming Pool �"`'�,���
I hereb certi that I ins eded the eledriml in Ilation described herein o af s e
Irrigation Boom Rough-In � D°�e
Special Inspection `
Finol �
Irnestigative Fee ��—�---�- 1 —
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 1 MONTHS.
2 9 9�� O 7 OFFICE USE ONLY This request void 18 monihs from validation date printed in this boz.
w�. �.. � t �..� : /�.
2���� �.�1�
PLEASE PRINT OR TYPE
Request Date Rough-in inspedion required2 ❑ Yes ❑ No Inspedion Other Than Rough-In: ❑ Ready Now � Will Call
(You must call the inspedor when reody) Date Ready:
I, ❑ licensed contractor ❑ owner hereby request inspection of the above electrical work at:
1ob Address ($ireef, Box, or Route No.) Ciy r. . Zip Code
� � �� ,
Sedion No. Township Name or No. Range No. Fire No. County ��
�
i I`-
Power Supplier
4
Eledrical Conirador (Company Name)
Address
Phone No.
Coniractor License No. � Master Lic. No. (Plant Elect. Only)
Mailing Address (Conhactor or Owner Performing Installafion)
L
Authorized�Signofure (Conhador or Owner Performing Insfallation) Phone No.
EB-OOOOlA-10 6/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACKOF YELLOW COPY