P - 82641I�IIIII�II�IIIII�IIIIII IIII IIIII IIIIIII�I� II�II 8E1�UEversaOAve., dRm. S-1c8ASt.'PauP MNT5�5104 ����
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� 0 2 9 9 3 4 3 4* Pnone (s12) sa2-oso�
Home Duplex Apt. Bidg. Other: New Addn
Commercial Industrial Farm ��' �� °`����/y�"�%C� Remod Re ai
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
D er Ran e Elec. Heat Tem .$ervice
"X" above the work covered by this reqvest. Enter remarks in this space and on the back of the white copy only.
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # Service Entrance $rze Fee # Circuiis/Feeders Fee
Mobile Home Park Stall � 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'SUSeoN y TOTAL
Sign/OutlineLtg.Xfmr. ��� �ij���j ►7'�c'ti—'� ��•5�
Alarm/Remote Control ��� t� �� �,�i
Swimming Pool
I hereb ceAi ihaf I ins ected ihe eledncal insiallation described herein on the daMs stated
Irrigation Boom Raugh-In Date
Special Inspe p
Final ��+. /
Investigative F
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
2 9 9� 3 4 3� OFFICE USE ONLY This request void 18 months from validation date printed in this box.
�L ��, � �
PLEASE PRINT OR TYPE
Request Date Rough-in inspedion required2 � Yes � Inspedion Other Than Rough-In: � Ready Now Will Call
i_� �.. ("'� .- �` (You must call 1he inspedor when ready) Date Ready:
I, ❑ licensed contractor �owner hereby request inspection of the above electrical work at:
1ob Address (Streef, Box, or Roufe No.) City Zip Code
S� �% � i\i � N s-T�'� L L i- l-� l � C.-C: � S�+4 3 �3.
Sedion No. Township Name or No. Range No. Fire No. Counly
�3 G� � �l- � jV C`, (c.�t
���l�H
Power $upplier
N S C-''
Eledrical Contmctor (Compan}
� Y1i i�f � /��
Mailing Address (CoMrador or
S���L�
Authorized Sanature_(CoMrad�
E8-OOOOlA-10 6/95
S� t�i l � i--
Phone No.
� ����v��
Address
1�� �� 5 �;��� 7 H 'D �� c S �onl
Contrador License No. Master Lic. No. (Plant Eled. Only)
J�iner fedorming InstallatiorA) ��/� Phone No.
�G '1 � `'1 � % — � c� j �
STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY