P - 84454I REGIUEST FOR ELECTRICkL It�SP�GTION ___
I I ��I I) III II (II II III II III (I (II I) III II (II I(III 8'21 Un essat AvearRmf S-1 8icdt. Paul �. .�.e� �r
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dy , , , 55 04
1� 0 2 9 9 3 5? 4� Phone (612) 642-0800 '�'
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Home Duplex Apt. Bldg. Other. ���,Z���a ��e.r�� ,�` �•1 Addn
Commercial Indushial Farm Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other. '
D er Ran e Elec. Heat Tem .$ervice
"k' above the work covered by this request. Enter remarks in this space and on the back of the whita copy only.
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee � Service Enirance $ae Fee # Ciraiis/Feeders
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
$treet Ltg./Traffic $ig. Above 200 Amps Above 100 Am
Trans{ormer/Gene�ator INSPECTOR'SUSEONLY TO�
$ign/Outline Ltg. Xfmr. �
Alarm/Remote Control
Fee
. oy�
Swimming Pool �� .— � ,�� ��
I hereb csrti that I ins e the eledrical installation described h fhe d s s
Irrigation Boom „r Rough-In D �^i
Specia) Inspecti ` '
Final
Investigative Fee ~' 2 �'j,�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
2 9 9- 3 5 7� OFRCE USE ONLY This request void 18 monfhs from validation dafe prinfed in fhis box.
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PLEASE PRINT OR TYPE � S� ����
Re �est te Rough-in inspedion required2 Yes � No Inspedion OTher Than Rough-In: � Ready Now Wil� Coll
� I� (You must ca�l the inspedor when ready) DaTe Ready:
I, lic sed contractor � owner hereby request inspection of the above electrical work at:
Job Ad� ss (Sheet, Box, or Roufe No.) Ci � O Zip ode� �
� � t,�.y
Secfion No. Township Name or No. Range No. Fire No.
�O ��
� �' G f
PowerSuppier �
Elechiwl Co �r (Company Name)
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Mailing Add�ont� � er Perfortning
Authori� $ignature �Contmdor or OwAerPerfom
�---,�� Q�t ��.Il�tt�s� �
EB- 1 A- 0 6/95 STATE BOARD COPY - SEE
Phone No.
S �2- ZZG /
� 1 �r ! (%i.Sl��
Contmdor License No. Master Lic. No. (Plant Eletf.
� �� Phone No.
- 2-Z
TIO�IVS ON BACK OF YELLOW COPY �"L�.; ��