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.
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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.
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EB- 1 A-10 6/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY
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