P - 83896I III) II III II III �� III II II� II III II III II III II (II I IIII $E�Uo es i� Be dR o SR� BASt.' PaulP, MNT5O5104 ��u�.
*•� � 2 3 2 7 2 0 3�c Phone (612) 642-0800 �°�'��'�
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Tem . Service
ove the work covered by this request. Enter remarks in this space and o the back o�hite copy only.
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Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # $ervice Enirance Sae Fee # Circviis/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps ;f�'�'b
Street Ltg./Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'SUSEONLY T�TiA� J—��
Sign/Outline Ltg. Xfmr. �
Alarm/Remote Control
Swimming Pool
I hereb ceAi that I ins eded ihe eledncal installation described herein on the dafes stated
Irrigation Boom Rough-In Date
Special Inspedion � M
inal �a '
Investigative Fee � O— —
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
^��_�� O OFFICE USE ONLY This request void 18 months from validation date prinied in }his boz. -' �� �
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PLEASE PRINT OR TYPE /`��
Request Date Rough-in inspecfion requiredZ � Yes '�No Inspedion Other Than Rough-In: � Ready Now %� Will Call
n '"`
(You must call the inspedor when ready) Da}e Ready:
I, licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job �ress ($iree�Box, or Rouie No.) Ci Zip Code
6 � �" ` s-s� �
Sedion No. Township ., me or No. Range No. Fire No. ounty �
Power $upplier
Ele�l C� r mpa , Name'�
Mailing Address (Contrador or O� ner Performing I
�--�-��] Phone No. + ^�� �y
'a�Y(l� %CJ S � �
P,ddress
Cantroctor icense No. Master Lic. No. �Planf Eled. Only)
� �. G � O /�3�3
`F��'v "v'�� "i'/viI r "'��/�
Phone No.
10 6/95 STATE BOARD COPY- SEE INSTRUCTIONS ON BACK C+F YELLOW COPY
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