P - 82664I.I�ii �I ��II III !I III II III II III II III II III I� I�I I I�II 821�Uni eSsaOAve. Rmo S-�1c8ASt.f PauP MNT55O104 5������%
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Phone (612) sa2-0 ��� 9���
ome Duplex Apt. Bldg. Other. f ^ � New Addn
Commercial Industrial Farm � ��" S Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
D er Ran e Elec. Heat Tem . Service � �g c �'(*
"X" above the work covered by this request. Enter remarks in this space and on the back of the w ite copy nly.
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # Service Enfrance $ize Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps ,�
$treet Ltg./Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL7
Sign/Outline Ltg.Xfmr. �h�1-.�` � �7-f� J•.
Alarm/Remote Control
Swimming Pool
I hereb certi that I ins eded ihe eledriml installation described herein on ihe dates staied
Irrigcition Boom Rough-In _ D
Special Inspe n � �� ` /�
Investigative - ���0� � C�Lac1l
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 1 MONTHS.
2 9 9- 3 4 4�] OFFICE USE ONLY This request void 18 mon}hs from validation date printed in ihis box.
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PLEASE PRINT OR TYP �
Request Date �Rough-in inspection required2 �1'ef � No Inspection Other Than Rough-In: �dy Now � Will Call .
t�, , (You musf call the inspedor when ready) Date Ready:
I, ❑ licensed contractor owner hereby request inspection of the above electrical work at:
Job Address (Sireet, Box, or Roufe No.) City Zip Code
� �� ��� c._ �� c�-� cQ��_ s s 43 z
SecFion No. Township Name or No. Range No. � Fire No. CouQ
a° � 1
Power $upp ier Ad res;
Y ��
Electrical Contracfor ( ompany Name)
C�`) Cl��ll �(�� �
Mailing Address (Conirador or pwner Performing Installation)
.--� 1� �r. �
or Owner Performing
EB-OOOOlA-10 6/95
No.
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�� • ►►�� tr�- � � V i
Coniraclor License No. Master Lic. No. (Plant Elect.
on� I P� /o.
24 8��: � 'z
SEE INSTRUCTIONS ON BACK OF YELLOW COPY