P - 82690,;t �I��I ��) II III I� II! II III II III II III II (�I II III I I�I) gE�U E eSsaOAve. Rm� S-�1c BASt.' PauP M N 550104 ���i
�* 0 2 9 9 3 4 7 5� Phone (6i 2) 642-0800 � ' ��`�� "'�
Home Duplex Apt. Bldg. Other: d � -/t New Addn
Commercial Industrial Farm Q � Remod Re air
Air Cond. Hig. Equip. Water Htr. Load Mgmt. Other:
D er Ran e Elec. Heat Tem . Service
"X" obove the work covered by this request. Enter remarks in this space and on the back of the white copy only.
Calculote Inspection Fee - This Inspedion Request will not be accepted without the correct fee:
Olher Fee �# Service EMrance Size Fee # Circuits/Feeders
Mobile Home Park Stall 0 to 200 Amps ' 0 to 100 Amps
$treet Ltg./Traffic Sig. Above 200 Amps Above 100 Am
Transformer/Generator INSPECTOR'SUSEONLY TOTA
Sign/Outline Ltg. Xfmr. � �
Alarm/Remote Control �����' „ � � _s�,
Swimming Pool �/�
I hereb cerli that I ins cled the elechical installafion described herein on eth dates
Fee
/ ��
Irrigation Boom Rough-ln
Special Inspe
Final Date �
Investigotive Fee
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
2 9 9_ 3 4 7 OFFIC USE ONLY This request void 18 months from validafion date printed in this box.
��n
( I �
PLEASE PRINT OR TYPE
Request Dafe Rough-in inspedion roquiredZ a Yes � No Inspeclion Other Than Rough-In: � Ready Now ill Call
�. �— � (You must call the inspMor whan reody) pale Read�_
I, ❑ licensed contractor �' owner hereby request inspection of the above electrical work at:
11ob' Address (Sheet, Box, or Route No.) � ^ City `, Zip Code
r C' • �i � F
� or No. Range No. Fire
�3v a �
oa���,
G..�. �\ � o� �-
Power Supplier
'V J�
Mailing Address (Con}ra
Authorized�i ature (Cc
,
EB-OOOOlA-10 6/95
Address
or Owner Performing Insrollahon)
Ll � ( �
cror or Owne Performing sTall ion)
STATE BOARD COPY- SEE
�\�� � � I Phone
,
License
�
��
Lic. No. (Plant Eled. Only)
8 � � I Phone No �.`
57
ONS ON BACK OF YFILOW COPY