P - 75822�� 111 II UI II III II III (I �I II III II III II II� ( IIII 821�UoNe� A ear�of ES.I_e1c�tricSY.' PauP MN�55104 -:�
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Home Duplex Apt. Bldg. Other: ���/,��� ���►�� New Addn
Commercial Indusfial Farm �� Remod Re ir
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other f��G,% `�
D er Ran e Elec. Meat Tem . Service
," above the work covered by this request. Enter remarks in this space and on the 6ack of the white copy only.
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Olher Fee # Service Gfi�ance S� Fee � Crrcvils/Fceders
Mobile Home Park Stall 0 to 200 Amps Q� 0 to 100 Amps
Street Ltg./Traffic Siq. Above 200 Amas Above 100 Am
Fee
enerator INSPECTOR'S USE ONLY TOT ^� p
g. Xfmr. � _..,
Control
� I here ce ' that I ins the aledrical inafallaHon described herein on the datee stated
IRigdtion Boom Rough-In p�
Special Inspecfion t/►'+ — %��.23 ' �'S
Investigafive Fee Fi�°I p�- ��
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
2%� �� O O � OFFlCE USE ONLY This request void 18 moMhs from wlidaHon date pri�ed in this box.
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PLEASE PRINT OR TYPE
�9� � Rough-in inapadion required2�� ❑ No Inapedion 01her Than Rough-In: ❑ Ready Now�1`YVtll CaII
���� �� (You must mll fhe inapeclor when ready) �te Ready:
I, �'licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Shee1, Box, or Route NoJ City Tip Code
p L:" f- %. �:�% S' s�
Sedion No. Township Name or o. Range No. Fire No. Coun � /
Power Supplier O
Eledriml CoMrador (Compoiry Name)
/�/'!v6 .��� � . "C
Maill� Addr�s (Contrador or Ownm Perfortnirtg
� o s'� 1 �
rized Signature (CoMradar or Owner Perfom
EB-OOOOlA-10 6/95 STATE A
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l�dresa
Contrador License No.
�n CriO%��/
..u..x...a
' � ( �'�
No. (PIarM Eled. OnIY)
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f� ' 9�a ,�c �'/�.�5�' S /1
Phorre No.
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INSTRUCTIONS ON BACK OF YELLOW COPY