P - 82673- I�� II III II III II III II II) I) I1I II III II III II III I IIII BEQ�ota SsaO Be. REo S-�1c 8ASt.1 PauP MNT5O5 04 �������
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Home Duplex Apt. Bldg. Other: New Addn
ommercial Industrial Farm Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Ran e Elec. Heat Tem . Service
"X" above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
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Calculate Inspection Fee - This Inspection Request will not be accepted without fhe correct fee:
Other Fee # Service Enha Size Fee # Circuiis/Feeders Fee
Mobile Home Park Stall 0 to 00 Amps 0 to 100 Amps
$treet Ltg./Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'SUSEONLY TOTyA�L �
$ign/Outline Ltg. Xfmr. �.�/�
Alarm/Remote Control
Swimming Pool
I hereb certi }hat I ins eded !he eledrical installation described herein on }he dafes stated
Irrigation Boom Rough-In Date
Special Inspe 'on
Final ��t z^�2—�j,�
Investigative
THIS INSTALLATION MAY BE ORDERED DISC NECTED IF NOT COMPLETED WITHIN 18 MONTHS.
^ w O_ O� O � OFFICE USE ONLY This request void 18 monfhs from validafion date printed in this box.
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PLEASE PRINT OR TYPE �
Re�st Date s�� Rough-in inspedion required2 es � No Inspection Other Than Rough-In: � Ready Now ill Call
2 6 (You must call the inspedor when ready) Date Ready:
I,�licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (S}reet, Box, or Route No.) _ City _ J � Zip Code _
No. � Township Name or No. � Range No. � fire No.
/" //>G/�Ic?
Power $upplier
NJ�
Address (Conirador or OGn'f Performing
A-10 6/95
�
ddress
License No.
Phone No.
.� �� 9��
0
Master Lic. No. (Plant Elect. Only)
�wner Performing Installation) '��^ r,,,, �� / P
_ TJ j � � l
STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY