P - 83568I IIII II III I� N� il III II III II III li li� II (II (I ��I �(��I 82� � E gssaO B a dR � S-�1c 8ASt.' PauP M NT55�104 ������
*��0 3'� 4 7 1 7 0* Phone (612) 642-0800 �`'' '"�
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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 .$ervice
"k' above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
,�'�D �i�zviG.g �i�r�� A'�D pr�� #�- ►�w e����S
Calculate lnspection Fee - This Inspecfion Request will not be occepted without the correct fee:
Ofher Fee # Service Entrarwe $ae Fee � Cimiils/Feeders Fee
Mobile Hom Pdrk StoN ( 0 to 00 Amps �•�' ?j 0 to 100 Amps /'°
Street Ltg./Traffic $ig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'SUSEONLY 70TAL �p
Sign/Outline Lig. Xfmr. yO � �`-
Alarm/Remote Control
Swimming Pool
1 hereb ceAi that I ins the elechical installafion described herein on the dates stated
Irrigdtion Boom Rough-In ��
$pecial lnsp �
Final
(nvestigative Fee ` � Z Z—
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITNIN 18 MONTHS.
3�/� ��� 7 OFFlCE USE ONLY This request void 18 months from validafion date printed in this box.
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PLEASE PRINT OR TYPE
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Requesf Dafe Rough-in inspxlion required2 �s � No Inspettion Other Than Rotgh-In: � Ready Now � Will Call
''7 /'L� -rt' (You must wll the inspecrorwhe� ready) Dah Ready: �Z Z� g
I, [�'Ticensed contrador ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sheet, Box, or Ro�te No.) Ci1y Zip Code
'�70� !�%/fS'/�f yn D N S I IV f �el7j L� �
Secfion No. Township Name or No. Range No. Fire No. Counly
Occu t Phone No.
��L S7e — (.�SSo �-5
Power $upplier Address � % � �
N�� �t� ��£ °`�� � N: 3'" �'�`
Electrical Confrador (Company Name) Controdor License No. MasMr Lic. No. (Plant Eled. Only)
�jN��}- �✓�c� � ,�►-�. � �-1L 9/�'1
Mailing Address (Contracror or Owner Performing In ation)
ZY`�`� �E S% s�.�T 2�9 1. (,/%�, S�t l�
Authoriz nature ( r or O r P ortni n Ila' n) � �" : Phone No.
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EB-00001 A-10 6/95 E BOARD C - SEE INSTRUCTIONS ON BACK OF YELLOW COPY