P - 82935! IIII �III �l �II II III II III I� III II II) �I II) II III I IIII 8E 1�Uni ess ty Ae., REm. S-�1C 8ASt.' PauP MNT5�5 04 �� �u�3i
�� * 0 3 3 4 8 6 6 1* Pnor,e �siz� saz-oaoo ������
ome Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod e air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
D er Ran e Elec. Heat Tem . Service
"k' above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
�c��cZ �ORm Qci►�via.��- ��V � � �.�-�"Rcn� C�
Calculate Inspection Fee - 7his Inspection Request will not be accepted without fhe correct fee:
Ofher Fee # Service Enirance ' e Fee # Circuits/Feeders
Mobile Home Park $tall 0 to 00 Amps 0 to 100 Amps
Street Ltg./Traffic $ig. Above 200 Amps Above 100 Am
Fee
Transformer/Generator INSPECTOR'SUSEONLY TOTA f j'tj
Swimming Pool
1 hereb certi that I ins ecled the elechirnl installafion described heroin on the dates stated
Irrigation Boom , Rough-In ��e
Special Inspe
Final � +� 7 s, t
Investigative Fee ��.� ��
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
3�^���� OFFICE USE ONLY Thia requeaf void 18 monlhs from validation dote printed in this box.
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PLEASE PRINT OR TYPE
Request Daie Rough-in inspedion requiredi � Yes o Inspeclion Other Than Rough•In: j
�-1 �� �� (You must wll the inspedor when ready) Date Ready:
I,�icensed contractor ❑ owner hereby request inspecFion of the above electrical work at:
Job Address ($ireet, Box, or Route N Ci
lntf� 3 �, ��Js�� �� ��-�r����/
� Seciion No. � Township Name or No.
IPower
Address
EB-OOOOlA-10 6/95
Fire No. Count
Phone
�1 1 � 1 1 �/. . J
� � � �dress
Name) ConNa r License No.
� / /
Owner erformin Insfallation) � �` �t
� �i
r or er Perf in ins fion)
STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELU
i� �
Master Lic.
�eady Now � �II Call
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Zip Code
S.S/�Y
�na No.
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