P - 83927I liil �� �� II II� II ill II III II �II (I III II (II II III I IIII 8E1�U E eSsaOAve., REm. S-�ic 8ASt.I PauP MNT55O104 ����
'� 0 2 9 9 4 1 8 4* Phone (612) 642-0800 �'�`�`�� "'�
Home Duplex Apt. Bldg. Other. �� �c) �;�a New Addn
Commercial Industrial Farm �� Remod Re air
Air Cond. Htg. Equip. Water Hir. Load Mgmt. Other:
D er Ran e Elec. Heat Tem . Service
X" above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
Calculate Inspection Fee - This Inspection Request wili not be accepted without the correct fee:
Other Fee # $ervice Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park $tall 0 to 200 Amps / 0 to 100 Amps S��
Sireet Ltg./Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'SUSEONLY TOTA
Sign/Outline Ltg. Xfmr. �2��, ���� � S�
Alarm/Remote Control
Swimming Pool
I hereb certi ihat I ins ected the elechical installaTion described herein on the dates sTated
Irrigdtion Boom Rough-In ��
$pecial Inspedi y�� ��
: t .' Final D< /r� ��
Investigqtive Fe !
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
2 9 9- 418 OFFlCE USE ONLY This request void 1 B months from validation date printed in ihis box.
�' �.�-- .��- �c�; �� t.�'-�,
�
PLEASE PRINT OR TYPE
Requesf Date Rough-in inspecfion required2 Yes ❑ No Inspedion Other Than Rough-In: ❑ Ready Now Will Call
`/ t/� �� (You must coll ihe inspector when ready) Date Ready:
v
I, ❑ licensed contractor owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City ,^„ � �/ Zip Code
lS�� �P�Q�1 G�� lL���r.l .S�S�%3 2--
Secfion No. Township Name or No. Range No. Fire No. Coun�l w �
.j c.'i 2 '� o ���
O�cc,u�pa + � Phone No.
/ f� % � ,�OZ -' Ol�,,j-3
�
Power Supplier Address
s LS /l% � � (/
Eledrical Confrador (Companv Name) Contractor License No. Master Lic. No. (Plant Eled. Only)
Mailing Address ntrador or Owner Performing Installation)
Authorized Signature (Conirador or Owner Performing Installation) �. �� Phone N
' �"T'� lL' Y� G'"� G�-n � � � �/ /� �' �
EB-OOOOI A-10 6/95 STATE BOARD COPY- SEE INSTRUCTIONS ON'BACK OF YELLOW COPY