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ome� Duplex Apt. Bldg. Other: ����������C..s New Addn
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Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
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"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 the correct fee:
OIF�er Fee � Service Enfirance $ize Fee # Circuiis/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Lig./Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'SUSEONLY TOTAL)/�
Sign/Outline Ltg. Xfmr. /(�7, �
Alarm/Remote Control
$wimming Pool
I hereb certi that I ins eded Me elechical instollafion described herein on fhe dafes sfafed
Irrigdtion Boom Ro�gh-In Dote
$pecial Inspedi
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Investigative Fee t � c � � � �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 16 MONTHS.
2 9 9- 3 7 6� OFFICE USE ONLY This request void 18 months from validation dale printed in this box.
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PLEASE PRINT OR TYPE � � �O ` � ����
Request Dafe Rough-in inspeclion requiredZ � Yes o Inspeciion Other Than Rough-In: � Reody Now � i I Call
„`6_Q (You must call ihe inspedor when ready) Date Ready:
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I, ❑ licensed contractor � owner hereby request inspection of the above electrical work at:
Job Address (Sheef, Bo or Route No.) City Zip Code
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Sadion No. Township Name or No. Range No. Fire No. County
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Phone No.
Power Supplier Address
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Elecirical Confracfor (Compony Name) Contmdo� License No. MasMr lic. No. (Planf Ele
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Mailing Address (Confmcior or Owner Pedorming Installation) -
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Authorized Signa (Conhncfoi or Owner Pe�fo/ming InsMllafion) � Phone No.
.���3 80- l?o
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