P - 83230IIIIIlt19i��lIIIII!!�IlIIIIIIlIIIIlIIIIIIIIIIIIIII 821�UE eS�aOAve. RE� S-�ic8ASt.IPauIP, MNT5O5 04 n?�. ����`a
* t] 3 4 1 9 6 8 6� Phone (612) 642-0800 ��'����
Home Duplex Apt. Bldg. er: � New Addn
Commercial industrial Farm Cd /QflZ%" Remod e air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Ran e Elec. Heat Temp. Service
"k' above the work covered by this reque;f, Enter remarks in s space and on the back of the white copy only.
��,���IGE SLt✓/ t� !`�i��✓ �� — � /N /6CJ�4TTil �H'(�iQ�i
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Calculate Inspection Fee - This Inspection Request will not be accepted without the corred fee:
Ofher Fee # $ervice Erdrance ae Fee # Circuiis/Feeders Fee
Mobile Home Park $tall 0 to 00 Amps L f' 0 to 100 Amps �jp "�
Street Ltg./Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPEC7oR'SUSEON�Y TOTA�� �,.r
Sign/Outline Ltg. Xfmr.
Alarm/Remote CoMrol �
Swimming Pool ,,f'7►
I hereb ceAi that I ins the eledrical insMllafion described herein on the dates sTat
Irrigdtion Boom Rough-In Dak
$pecial Inspecti
' Final Date/ _;�_9�
Investigative fe �$� 6
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT CO�APLETED WITHIN 18 MONTHS.
������+ � OFFICE USE ONLY This request void 18 mo�ths from validafion date printed in this box.
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PLEASE PRINT OR TYPE
Requesf Daie Rough-in inspection required2 ❑ Yes �o Inspeclion Othar Than Rough•In: eady Now ❑ Will Call
� (You must call the inspector when ready) Date Ready: L
I, licensed contractor ❑ owner hereby request inspecFion of the above electricol work at:
Job Address (Sheet, Box, or Rouk No.) City Zip Code
�iZS� J4 �7� �•a�✓L iC S�S
SecFon No. Township ame or No. Range No. Fire No. County
���
OccupaM � Phone No. �
.Sco ?-r S'•�.o�c,%�' ,f'7 /�/. >S%
Power Supplier Address
S,� / C'E✓7 �t ir+r ' as .3:J7
Ele 'm) Conhactor (Compony Name) � Contractor License No. Master Lic. No. (PlanT Elect. Only)
s �� .��. G',�d �----
Mailing Address (Conhacror or Owner Performing InsMllation)
7%3/ /��Zlr�r .�}�i. � ' .�l'r y3z
Authorize�Si re �C n� or er Performing Instal h� ` j� � p� � Phone No. �
CJ �� "�' a'.�`� .�%� ��
EB-OOOOlA-10 6/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY