P - 84740( I�I II 111 I� III (I III I) II) I) III (I III II II) II ��I I I�I) g21�Un' e s�OAve REm. S-�1' BcSt.' PauP MNT55104 u��
�* 0 2 9 9 0* � � � �
� 9 � Phone (612) 642-08 ,,,, �
Home Duplex Apt. Bldg. Other: ��- 'J< r New Addn
Commercial Industrial Farm '�3 •l � 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.
GF/�1-�t/G� �tS� 3� x To c�,� cr�i7� �32c'�kF�S
Calculate Inspection Fee - This Inspection Request will nof be accepted withouf fhe correct fee:
OIF�er Fee � Service EMrance Size Fee � Circuils/Feeders Fee
Mobile Home Park Stall t 0 Amps 0 to 100 Amps
$treet Ltg./Tra�c $ig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'SUSEONLY TOTAL %
Sign/Outline Lig. Xfmr. �� � �"�
Alarm/Remote Control
Swimming Pool ,�'i �. �_ � �
I hereb cefi fhaf I ins ed the elechical installafion describe6'N�re fh ks
Irrigation Boom Rough-In � y
Special Insp - � ��
Final
Investigotive e -,�-
THIS INSTALLATION A�E ORDERED DtSCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
2 9 9— 3 9 7� OFFlCE USE ONLY This request void 18 months from validafion date prinied in this box.
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i
PLEASE PRINT OR TYPE
Requesf DaM Rough-in inspecfion required2 � Yes � No Inspection Other Than Rough-In: � Ready Now � Will Call
7 Z. �% � Q% (You must call the inspedor when reody) Date Ready:
I, ❑ licensed contractor � owner hereby request inspection of the above electrical work ot:
Job Address (Sheef, Boz, or Roufe No.) City Zip Code
� 3 j�D y�Nec i' s� �tJ� r/L/ D�c'�`7 ss=F32
Sedion No. Township Nome or No. Range No. Fire No. County
� O 2 � iVoNc ,¢,VD �
Occupanf Phone No.
To� .e.��1os s�/ - �3 5<9
Power Supplier Address
!US � �l��S �/. �� V
Elechical Coniracfor (Compony Name) Contrador License No. Master Lic. No. (Planf Elect. Only)
d !�v' �t/��
Mailing Address (Conhacior or Owner Performing Installafion)
S/qti1 � :��
Aufhorized $ignafure (Controclor or Owner Performing Inslollafion) Phone,No.
..?r.�- O 'Q �i� 5�3 �9
EB-OOOOlA-10 6/95 STATE BOARD COPY- SEE INSTRUCT1bN90N BACKOF YFILOW COPY ,� .� o as� y�-