P - 82700I�I� �I� II III I� ��I I� lil �� III I� II� �I (II II �II I I��� g21�U E essi OAve. Rm� S-�1c gAS I PauP M`N 505104 ����
tY � . , `��......;�
�- * � 2� 9 3 4 2 6* Phone (612) 642-0800 `� �'�
Home Duplex Apt. Bldg. Other. 1!"iC: {�lew Addn
Commercial Industrial Farm S� Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other: z
Dryer Ran e Elec. Heat Tem . Service {-,� `� ' �+�y �� '/1% �
"k' above the work covered by this request. Enter remarks in this spoce and on t e ack of tRe whife co y only.
Cafculate lnspection Fee - This lnspection Requesi will not be occepfed without the correct fee:
Other Fee # Service Erdrance Size Fee # Circuits/Feeders Fee
Mobile Home Pork StaN 0 to 200 Amps 0 to 100 Amps
$treet Ltg./Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generotor lNSPEC7oR'suSEONLY TOTAL �� ��
Sign/Outline Ltg. Xfmr. ��
Alarm/Remote Control
Swimming Pool I hereb cerfi thaf ! ins ec�ed the eleckical insfallation desaibed herein on 1he dafes s�tod
Irrigdtion Boom Rough-in Da
$pecial Insp • — — 05'��" � �a� �
� Final Date
Investigative e ..
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONT S.
2 9 9- 3 4 2� OFFICE USE ONLY This requesf wid 18 monlhs from validation dote pnnted in fhis boz.
�� �
PLEASE PRINT OR TYPE �
Request Date Rough-in inspection required$ � Yes �No Inspeclion Olher Than Rough-In: [,] Ready Now � Will Call
f� / // f' (You musT call the inspector when ready) Dote Ready:
I, ❑ licensed contractor �owner hereby request inspection of the above electrica► work ot:
Job Address (Strcet, Boz, or Route No.) Ciy Zip Code
�U, .nl f�-�/�' N; �_ �icsal�� .S�.S�4�,� J--
Section No. Township Name or No. Ronge No. Fire No. Couny
.�o � ' ��
Occupanf Phone No.
��,,.-i S�� S% rf _.� 3 A
Power Supplier Address
n/ f /�'I S Nb, .. i l/
Elecirical Contraclor (Company Name) Conhacror license No. Master Lic. No. (Plont Elecf. Only)
C7(�� fe„
Moiling Address (Contractor or Owner Performing Installafion)
s �
Au rized $i notum (Conhactor or er Pedo ' Installafion) Phone No.
. ._ �__ _ _ .� �'-+'�-..:'.. e :� g�'7 —eZ�6' 36
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E 1A-10 6/95 STATE BOARD COPY- SEE INSTRUCTIONSON BACKOF YELLOW COPY