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 ,(/
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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.
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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/�
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Phone No.
7 �dk/�
Power $u plier Address
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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