P - 84515I(III� III I) III II II) O (II II II) I) II) II III II III I I�II MS QUotv SsaO Be. dR � S-�1 BASt.' PauP MNT55104 �u��
�� 0 2 9 9 3 6 2 4* Pnone (s12) s�a2-os �� '�:�
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm � • � Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
D er Ran e Elec. Heat Tem . Service
"k' above the work covered by this request. 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:
Olher Fee # Service Enirance Size Fee # Ciraits/Feeders
Mobile Home Park Stall 0 to 200 Amps i 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Amps Above 100 Am
Fee
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
Sign/Outline Ltg. Xfmr. �� ��
Alarm/Remote Control
Swimming Pool
I hereb ceAi }hat I ins ecfed the eledrical insfallation described herein on the dates stated
Irrigation Boom � Roogh-In_ h L� Dar� — 2( 9
Special Inspe _ �
Final p� �
Investigative Fee • --�'�---- +� `Z--z' �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
2 9 9��� 2 � OFFICE USE ONLY This request void 18 months from v� � oryda printed in this box. /�/�
/�
�
PLEASE PRINT OR TYPE
Request Date ' Rough-in inspecfion required2 �Yes � No Inspection Other Than Rough-In: 0 Ready Now Will Ca�l
.� (You must coll ihe inspedor when ready) Dote Ready:
I, ❑ licensed controctor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sfreet, Box, or Route No.) City Zip Code
I � � � S7 �� Z � S� `}3'Z
Sedion No. Township Name or No. Range No. Fire No. County
� Z`t � 1a N 6 u,A
Occupant Phone No.
p a� C�. �� K.� S`Z 1-78 Z
Power $upplier Address !
� G ! !/ l � ,
Elechical Conhacior Lompany NartJ@) Contrador License No. Master Lic. No. (Plant Eled. Only)
Mailing Address
EB-OOOOlA-10 6/95
or Owner Performing InsTallation)
cipr or Owner e rming Installation)
J
ST E BOARD COPY - SEE
/'� � I Phone No.
�� S�i G O
1 ON BACK OP YELLOW COPY