P - 84343� ��II� I� III II III II III I) I�I II III (I (II �I II� I I��I 821�UE essf OAve., dRm. S-�1c8ASt.l PauP MNT5O5 04 ���U��'
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. Home Duplex Apt. Bldg. Other: New Add�
Commercial Industrial Farm Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Ran e Elec. Heat Temp. 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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Colculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Ofher Fee # $ervice Enirance ize Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 00 Amps ^ 0 to 100 Amps
$treet Ltg./Traffic Sig. Above 200 Amps Above 100 Amps � �
Trans{ormer/Generator INSPECTOR'S USE ONLY TOT �/ti
Sign/Outline Ltg. Xfmr. ,�
Alarm/Remote Control
Swimming Pool
I hereb certi }haf I ins eded the eledrical insfallation described herein on the dates stafed
(rrigation Bo Rough-In �a} _ � _
Special Inspe
Final
Investigative Fee
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLE THIN 18 ONTHS.
3 3 8— 0(J 2 � OFFICE USE ONLY This request void 1 B months from validation date printed in }his box.
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PLEASE PRINT OR TYPE
Requesf Dafe Rough-in inspedion required2 �' Yes � No Inspedion Other Than Rough-In: ❑ Ready Now � Will Call
(You must call the inspedor when ready) Date Ready:
I, licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Add s(Sfr�,�t, Box, or Rou e No.) + City��'� Zip Code
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Sedion No. Township Name or No. � Range No. Fire No. Cou
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Power Supplie
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Eledrical Co fm r (Company � �lame)
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Mailing Address (Confrador or Owqer Performirn
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EB-OOOOlA-10 6/95 TAT .
Phone�o. , �•
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� Address� %G' � �� � ^ (`G/� � {' �I
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Coniraclor License No. � Master Lic. No. (Plant leci. O
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�s Ilation) . i
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ig InsMlla' ) � �/ P
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D COPY - S INSTRUCTIONS ON BACK OF YELLOW COPY
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