Loading...
P - 84632;��II�) �II II II� II III II III II (!) (I III II II) I� �II I I�II 821�Uo a SsaOAve., dR o S-1' 8ASt.I PauP MNT55104 ��`��. * 0 2 9 9 3 8 0 6 * Phone (612) 642-0800 � ��.� � Home Duplex Apt. Bidg. Other: 6 New Addn Commercial Industrial Farm l�' � Remod Re air Air Cond. Htg. Equip. Water Hir. Load Mgmt. Other: ����fj D er Ran e Elec. Heat Tem . Service "X" above the work covered by this request. Enter remarks in this spoce and on the back of the white copy only. Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee: Olher Fee # $ervice EMrance $ize Fee # Circuits/Feeders Fee Mobile Home Park Stall 0 to 200 Amps � 0 to 100 Amps $treet Ltg./Traffic $ig. Above 200 Amps Above 100 Amps Transformer/Generator INSPECTOR's usE oN�Y TOTAL (7, Sign/Outline Ltg. Xfmr. L �. Z� •z ��. 4-e � / "r �`�-' �'f � �' -� Alarm/Remote Control � y (�-S -- Swimmin Pool /"� _ �, 9 I hereb certi ihat I ins ecMd the eledriml insMllofion descnbed h n�athe dalf/siat� �` Irrigation Boom Rough-In pak $pecial Inspect' -K " n '" Z-'� - l Investigative Fee _. _ F�oal ����— po� / _ � ( THIS INSTALLATION MAY BE ORDERED DISCON CTED IF NOT COMPLETED WITHIN 18 MONTHS. 2 9 9�� 8 O ��'^` � OFFICE USE ONLY This requesf void 18 months from validation dnte printed in this box. 4� �\ PLEASE PRINT OR TYPE '�� /� � Request Dak Rough-in inspecfion required2 � Yes � No Inspeclion Other Than Rough-In: 0 Ready Now � Will Cal) �� ��' �� (You must call the inspedor when ready) Date Ready: I, ❑ licensed contractor � owner hereby request inspection of the above electrical work at: Job Address (Street, Box, or Route No.) City�7 Zip Code i0 rS� �� i �Z.r �C t� T'r � u� �e .5�/3�" `/�/S Seciion No. Township Name or No. Ranga No. Fire No. County — 3c� a�/ — ,4�0 Occupant Phone No. Na. �. �� f. �rq �� ~ �Y.�3 Power $upplier Address `n S � � � �-.� �J ,.,e . Elechical Contracfor (Company Name) Conhacior License No. Master Lic. No. (Planf Eled. Only) C9 1,,�}^'�1�� Mailing Addreas (Conhaclor or Owner Perfortning Installafion) S�-,�—�—� Au orized Signature (Contraclor o� er Perfortning Inslallafion) . Phone No. ��. _ �.,�.�, r� �5 s-��-�y3 3 EB- 1 A-10 6/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY �— �,���� �.✓