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P - 83939�I.I�II II III II III I� II) II I�I II ��I (I (II II III II ��) I I��I 82�uota S IatO B a R�o SR cCAS I N SP M�50 04 ���� � * 0 2� 9 4 2 0 0* Phone (612) 642-0800 �� ��� �-��"a���y� Home Duplex Apt. Bldg. Other: �� � y� yy� ,� �- ��, New Addn Commercial Industrial Farm �'y� Remod Re air Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other: Dryer 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 whits copy only. %i� O ✓-� �'1-��� Y a' °� � � Y►'t S .D � L Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee: Other Fee # $ervice Enira Size Fee # Circuiis/Feeders Fee Mobile Home Park Stall 0 to 00 Amp s(,�j,' 0 to 100 Amps ,G Street Ltg./Traffic Sig. Above 200 Amps Above 100 Amps Transformer/Generator INSPECTOR'SUSEONLY TOTAL Sign/Outline Ltg. Xfmr. � ��'S� Alarm/Remote Control Swimming Pool � �2 -�/�— t� I hereb ceAi ihat I ins eded ihe eledrical insfallation described herein the d es sta Irrigation Boom Rough-In '' / Q� Dare Special Inspedio ' � � G'--c�-�- ^--- /' % � /— , c. Imestigative Fee F�nol ,(/ , U THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS. 2 9 9- 4 2 0 OFFICE USE ONLY This request void 1 S months from validafion date prinfed in ihis box. ��s��7 � ��ld"'c/ PLEASE PRINT OR TYPE ��(� -SZ� Request Date Rough-in inspecfion required2 Yes � No Inspedion Other Than Rough-In: � Ready Now ill Call 1,.,� 1'3 .� � (You musf call ihe inspedor wh ready) Date Ready: � I, licensed contractor ❑ owner hereby request inspection of the above electrical work at: Job Addreu (Sfreef, Box, o Route No.) City Zip Code lOS�/ �rc�.�r �•k�b�E S-'SY Sedion No. Township Name or No. Range -�� / Fire No. Cou ry/� �.=� �`Y /'ii �.. . � .._ Phone No. 7 �dk/� Power $u plier Address � � Elechical Contrador (Company ame) s �i .V�t.- - � Mailing Address �Confrador or Owner Performing Installation) �� 3 L.? 2 ��10�-F Authonf,�d Signature�(faerytraclor or Oy�ner Performing Installation) A-10 6/95 STATE BOARD COPY - SEE oniracior License No. Master Lic. No. (Plant Eled. Only) � �1 / � �^ � � /� � • �. Phone No. 7'� `��% � I N ON BACK OF YELLOW COPY