917 Lone Oak Rd - Electrical PermitsREQUEST FOR ELECTRICAL INSPECTION
/°2lr-?'/7 ?-?.r`? / * See instructions lor completing ihis form on back of yellow copy.
M 7 3 771 `X" Below Work Covered by This Request
?'?"`•? es-ooooi-oa
? E
ew Add Rep. Type of Building AppliancesVVired EquipmentWired
Home Range Temporary Service
Duplex Water Heater Electric Heating
Apt. Building Dryer Load Management
CommJindustrial Fumace Other (Specify)
Farm Air CondRioner
Other (specify) Contractor' Remarks:
Compute Inspection Fee Below:
# Other Fee # ServiceEntrance5ize Fee # Circuits/Feeders Fee
Swimming Pool 0 to 200 Amps 0 to 100 Amps
Transformers Above 200 _ Amps Above 100 Amps
Slgns Inspectar5 Use Onry: TO'?1L ?
Irrigation Booms U `? 70.
Special inspection
Alarm/Communication THIS INSTALLATION MAY 8E QROER DISCONNECTED IF NOT
Other Fee ..Sa COMPLETED WITHIN NTH . r
I, the Electrical Inspector, hereby Rough-in ' Dat ? ?
certify that the above inspection has
been made. Final Date
OFFICE USE ONLY .
i
This request voitl 78 months fmm
? ?
?4?71/ -?a,; 0 ?'
Request Date
?? ire N. Rough-in Inspeclion
Fequied? .° NOTICE: Vou Must Call Elecirical Inspecror
If A Rough-In InspeMion
I?
7 ? Yes o Is Reqwred.
I icensed contractor ? owner hereby request inspection of above electrical work at:
Job Address (Street Boz or Route No.) City
9/7 4ol•F oAK Rpp° ,CACol
Seclion No. Township Name or No. Range No. County
,DAYcTJ4
Occupant(PRINT)
opos ?,??,???,? Phone No.
Power Supplier Address
?/?y?PoiLT
'^
s/..?
/ A
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7.
Electriral Contractor (Company Name)
AWZCZ`l ConVaclor's License No.
oyol 7
o/Wwii
Mailing Address (Contractor or Owner Making Installation) /*-jN U?.7 t'r_li?J?/
T
o'zl ffv"13n4o7-vr• S?8u,???.??.? Amokpftmt-
Authorized Signature (Con?ir y?^?ner Making Installatio )
,???"?-/.? Phone Num6er
li -
MINNESOTA STA7E BOARD OF ELECTRICITY THIS INSPECTION REQUEST WILL NOT
Griggs-Mltlway Bldg. - Hoom 5-173 BE ACCEPTED BY THE STATE BOARD
1821 University Ave., St. Paul, MN 55104 UNLESS PROPER INSPECTION FEE IS
Phone (872) 842-0800 ENCLOSED.
REDUEST FOR ELEC" ICAL INSPECTION Ee-ooooi- 9
G G ?/ , Sae insiructions for completing? form on back of yellow copy.
?
.S?Vlf? "X" Below.Work Covered by This Request
Ne Ad Rep. ?Type of Building Appliances Wired Equipment Wired
Home Range Temporary Service
Duplex Water Heater Electric Heating
Apt. Building Dryer Load Management
Comm./Industrial Furnace Other (Specify)
Farm Air Conditioner
Other (specity) Coniractors Remarks:
Compute Inspection Fee Below:
# Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Swimming Pool 0 to 200 Amps / 0 to 100 Amps
? Transformers $ ? 3. 50
Above 200 ffAW- Amps
-
Above 100 _Amps
519nS Inspector's Use Only: TOTAL
Irrigation Booms ? 5-.?
14
Special Inspection • ,
Alarm/Communication THIS INSTALLATION MAY BE O CONNECTED IF NOT
Other Fee COMPLETED WITHIN 18 MON
I, the Electrical Inspector, hereby
h Rough-in i I Dat' ^ 1?_?LJ
certity that the above inspection
as
been made
.
Final
Oale
OFFICE USE ONLY
This request void 18 monlhs hom
0-1 9-712 g?s 114)-?f 6 i
it
? ,
Requesl Date' Fire o, ugh-In
7?Speclion fiequiretl Inspection Other Than Rouqh-In
mus
(YOU II inspector when ready) 0 Reatly Now ? Will Notity Inspector
Yes ? No - Date Ready
I L7licensed contracror ?owner hereby request inspection of above electrical work at:
Job Address (S[ree4 Box or Route No.) Ciry
Section No. Township Name or No, . Range No. County
OccupaM (PRINT) Phone No.
L
Power Supplier Adtlress
Electrical Contracror (Company Name) Conlractors License No.
1
Mailing Address (Contractor or Owner Making Installation)
3
Auihoriz ig ature (COntradw/Owner king s Ilation PNumber
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1 11 11 111 1111 111 11 ?
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Phone (612) 642-0800 ? I OSD.
N
IIIIII) IIIIIIIIII IIIII REQUEST FOR ELECTRICAL INSPECTION ??
Minnesota State Board of Electricity
1821 University Ave., Rm. 5-128, St. Paul, MN 55104
* 0 2 3 7 8 8 7* Phone @)2j 642-0800
Home Duplex ApT. Bldg. Ofher: New Addn
Commercial Industrial Farm Remod Re air
Air Cond. Hig. Equip. Wafer H1r. Load Mgmt. Other:
D er Ran e Elec. Heaf T e m . Service
"k' above the work covered by this request. Enter remarks in this space and on the back of 1he whiie copy only.
A7 y/t,0O V 3g4 4 W 5A(/I Er- FZF..?L[l RES J`? M0rettz-
301e-?l4 X - F?ft p-
Calculote Inspection Fee - This Inspection Reqvesi will not be accepted withovt the correct fee:
Ofher Fee # Service Enfrance Sae Fee # Circvifs/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 4 0 to 100 Amps
SfreeT Lig./Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator S INSPECTOR'S USE ONLY TOTAqL
Sign/Outline Ltg. Xfmr. ? ( 3.
Alarm/Remote Control f
Swimming Pool I hereb <eAi that I ins e I 'ml i n ed e i on the d s stated
Irrigetian Boom Roagh-In Dal .?
ection
eciallns
S ?
p
p Final ? Da1 ?
V rInvestigative Fee
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
A w_^?^ ?
L 37 v b OFFIC USE ONLY This requesl void 18 monlhs from validation dote prinkd in tl?ijx boz.
l??
047 7 - -
-
?
ai
PLEASE PRINT OR TYPE _ •
,o
Request Date RougR-in inspecid required8 es ? No Inspeclion Other Than Rovgh-In: [] Ready Now 81 Call
&,21, G/ (You must mll fhe inspecror when ready) Dah Reody:
I, ?icensed contractor 0 owner hereby request inspecFion of ihe above electrical work at:
lob Address (Sheel, Box, or Roufe No.) rrVX-1?4 Ciry Zip Code
0117 E_
Township Nama or No.
Section No.
Range Na
Fire No.
Counly
I
0
Occupon} Phone No.
Power $uppliet Address
D
Elechical Conbacfor (Company Nome) Conimdor License Na. Masler Uc. No. ant Eled. Only?
? D 3
Mailing Address (Conimclor or Owner Performing Insfallofion)
3 5 7- 67SWO
AWhoriz , O n Perfo 'ng In Ilatlon) 7hona No.
fOS000iA-10 6/95 STATE BOARD COPY- SEE INSTRUCTIONSON BACKOF YELLOW COPY
f. I/C/_ 1%
?IIII ?III
?
* 2 3 7 8 1 IIIIIIIIII REQUEST FOR ELECTRICAL INSPECTIOW °K%4
Minnesota State Board of Electricity ??-
1821 University Ave., Rm. -12 S. Paul, MN 55104 ???
1* Phone (612) 642-0800 J??
Home lex Apt. Bldg. (9ther. -- New Addn
Commercial
Indusirial
Farm
Remod
Re air
Air Cond.
I I Htg. Equip. Water Hfr. Load Mgmt. Other:
D er Ran e Elec. Heat Tem . Service
"k' above ihe work covered by this requesf. Enter remarks in this space and on the back of the white copy only.
,X.?-7/4 FvV 3? 4 WU l y,Cs
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Olher Fee # $ervice Enfrance Size Fee # Circuiis/Feeders Fee
Mobile Home Park Stvll ? 0 to 200 Amps 0 to 100 Amps
$treet Lig./Traffic $ig. Above 200 Amps Above 100 Amps
Transformer/Generator ? INSPECTOR'suseoNLv TOTAL ?
$ign/Outline Lfg. X4mr. ?
Alarm/Remote Control ? j ?) ?
)
$wimming Pool
I herab ceni ihat I ins eded Nie elechica - a tio es '
in on iha daks smted
Irrigdtion Boom Rough-In Dore.
?_
z? ?O
2
eciallnspection
S ? °
°
p Fi
l D
f
/
nvestigafive Fee
S na o
e ^ yY
?
THIS INSTALLATION MAY 8E ORDERED DISCON E IF NOT COMPLETED WITHIN 18 MONTHS.
237_ 813 ? OF?CE USE ONLY This request void 18 monlhs (mm wlidaXon daM pnnted in ih
: a?/9io
? ??S
?
?
?
PLEASE PRINT OR TYPE /L,
,
Requast Dak Rough-in inspecti equired2 laOres [I No InspeCion OlharThan Rough-In: F] Ready Now []Will Call
(You must call ihe inapecior when reody) Dote Ready
I, p2iicensed contractor ? owner hereby requesf inspedion of }he above eledrical work at:
Job A,ddress (Shcei, 8oz, or RoWe No.) Cily Zip Code
"7
$eclion No. Township Name or No. Ranga No. Fire No. County
?
Otcupant Phone No.
D)F- Z,)qs
Power Supplier Address
vkieci* L 3 '
Elechiwl Conhactor (Company Name) Conimdor Ucense No. MasMr Lic. No. (Plont Elacf. Only)
L D3fo
Mailing Address (Contractor or Owner Per(ortning Installafion)
ST
FwlFiorirwtum (Conhocror or w?r Ped ing IlaAon) Phone No.
ill
94--
VEOW7b-10 6/95 1 STATE90AHDCOPY-SEEINSTRUCfIONSONBACKOFYELLOWCOPY
REQUEST FOR ELECTRICAL INSPECTION ?0'W? esAO?-o
10- See instruaions fnr r,omple[ing Ihi; iortn on back of yellow copy. •?
X" Below Work Covered by This Request
Ne Add Rep. Type of Building Appliances Wired Equipment Wired
Home Range Temporary Service
Duplex Water Heater Electric Heating
Apt. Building Dryer Load Management
Comm.Jlndustrial Furnace Other (Specify)
Farm Air Conditioner
Other (specity) Coniraclor'S Remarks:
Compute lnspection Fee Below:
# Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Swimming Pool 0 to 200 Amps 0 to 100 Amps
Transformers Above 200 Amps Above 100 _Amps
SIgf1S Inspector's Use Only: T
Irrigation Booms ? •? 20.50
Special Inspection
X Alarm/Communication THIS INSTALLATION MAY BE ORD DISCONNECTED IF NOT
Other Fee COMPLETED WITHIN 18 MONTHS.
I, the Electrical Inspector, hereby Rough-in Date
certify that the above inspection has
been made. Finai ? oa
OFFICE USE ONLY .
This request void 18 months irom
9?7cl 7 8
• a?
Requ st Date Fire o, ugh-IC Inspec[ion Required InspeCtion Olher Than Rough-In
06/20/95 (Y OU must call inspeclor when reatly)
? ? Ready Now E] Will Notify Inspecbr
? Yes
No Date Reatly
I,,??1 licensed contractor ?owner hereby request inspection of above electrical work at:
Job Address (Sireet, Box or Route No.) Ciry
917 Lone Oak Road Eagan
Section No. Township Name or No. Range No. County
Dakota
Occupant(PRINT) Phone No.
Lone Oak Commerce Center (612) 854-8893
Power Supplier Address
N/A N/A
Electrical ConUacbr (Company Name) Contractor's License No.
National Guardian Securit Services CC00428
Mailing Atldress (Contractor or Owner Making Installation)
Riverpla
Authonzed i ature (ContractorlOwner Making Installation) Phone umbe
.0 (612 673-6400
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CO
?/?/l c? REQUEST FOR ELECTRICAL INSPECTION
? See insimctions for completing this brm on back of yellow copy.
M 0 7 4 6 5 x° Sebw Wark Covered by This Request
EB-00001-08
445'/3S
ew Rtld Rap. - Type of Building AppliancesWired EquipmeniWired
Home Range Temporary Service
Duplex Water Heater Electric Heating
Apt. Building Dryer Load Management
Comm./Industrial Furnace Other (Specify)
Farm Air Conditioner
Other (specify) Coniractor§ Remarks:
Compute lnspection Fee Below.
# Other Fee # ServiceEniranceSize Fee #" Circuits/Feeders Fee
Swimming Pool 0 to 200 Amps 0 to 100 Amps
Transformers Above 200 _ Amps ove 100 _ Amps
SIgOS Inspeclor§ Use Only: TOTAI
.
Irrigation Booms ?
9
Special Inspection
Alarm/Communication Z THIS INSTALLATION MAY BE D DISCONNECTED IF NOT
Other Fee COMPLETED WITHIN 18 MONTHS.
I, the Electrical Inspector, hereby Rough-in Date
certify that the above inspection has
been made. F;,,ai Date
OFFlCE USE ONLY
This request void 18 manihs from
m 'O" r 4 6 5 ?ys?w?
t
? ?-
• s
Request Date Fire No. Rough-in Inspection NOTICE: You Musl Call Elecirical Inspec[or
Required? If A Rough-In Inspection
?Yes No IsRequired.
I licensed contractor ? owner hereby request inspection of above eiectricai work at:
Joh Address (Streel. Box or Route No.) City
1 l..o k- F Ar?
Section No. Township Name or No. Range No. County
VA&iA
Occupant (PRINT) Phone No.
Power Supplier Address
Electrical Contrector (Company Name) Contrector's License No.
F ?.? S S c. GGao S(Q
Mailing Address (Contractor or Owner Making I nstallation)
P. r SV l'1 Ro ?v ,
tAuthorized Si re ntrec[w/0 n ak' Instal tion) Phone Number
53('0 -3q sn
MINNESOTA STATE BOARO OF'ELECTHIpTY THIS INSPECTION REOUEST WILL NOT
Griggs-Midway Bldg. - Room 5-173 BE ACCEPTED BY 7HE STATE BOARD
7821 University Ave, St. Paul, MN 55104 UNLESS PRpPER INSPECTION FEE IS
Phone (612) 642-0800 ENCLOSED.
REQUEST FOR ELECTRICAL INSPECTION ???
4 ? ?A ee-ooooyos
O 2 2 See instmctions br completirtg this lam on back ol yellow copy.
' . "X" Below Work Covered by This Request `??,e??"" ?
New A?c'd Rep. Type of Building Appliances Wired Equipment Wired
Home Range Temporary Service
Duplex Water Heater Electric Heating
Apt. Building Dryer Load Management
Comm./Industrial Furnace Other Specify)
Farm Air Conditioner
Other (specify) Goniractor's Remarks:
Compute Inspection Fee Below:
# Other Fee # Service Entrance Size Fee # Circuits/Feetlers Fee
Swimmin Pool 0 to 200 Amps 0 100 Amps Zp
,Z Transformers Above 200 Amps I Abov 140 Am
Signs insPecrors use oniy: TOTAL
Irrigation Booms 1 j
Special Ins ection ? ?
Alarm/Communication THIS INSTALLATION MAY BE D DISCONNECTED IF NOT
Other Fee COMPLETED WITHIN 18 MONTHS.
I, the Electrical Inspector, hereby
certify that the above inspection has
been made. Rouqn-ir,
Final Date 1?
ace
OFFICE USE ONLV
This request vold 18 manths irom -
Sfa IS /?OOl?
0 312 2 4 1 ,
Request Dale ire No. Rough-In Inspection Required Inspection Olher Th n Rough-In
'
'?
4" Z (You call inspecior when ready)
mu ? qeady Now ? Will Notify Inspector
-
,? Yes ? No Dale Pead
Iy licensed contractor ?owner hereby request inspection of above electrical work at:
Job Address (Street, Box or Route No.) City
q ? -1 1-011 ooL4 Ro
Section No. TownsMp Name or No . Range No. Counry
Occupanl(PRINT) Phone No.
Power Supplier Address
Elemrical Coniractor (Company Name) Contraclor's License No,
i G ^ /? ? 1 d
Mai ing A tlress oNra r or Owner Making Inslallation)
`O? •
Authorizetl Si Phone N ber
"Iq q
MINNESOTA STATE BOARE) OF ELECTRICITV THIS INSPECTION REQUEST WILL NOT
Grfggs-Midway Bldg. - Room 5•128 BE ACCEPTED BY THE STATE BOARO
7821 University Ava., St. Paui, MN 55104 UNLESS PROPER INSPECTION FEE IS
Phone (672) 842-0800 ENGLOSED.
REQUEST FOR ELECTRICAL INSPECTION
11i, See insVUCtions for completing this lorm on back ot yellow copy.
"X" Below Work Covered by This Request
ee-ooo i-os
?
Ne Add ep. ype of Building' - Appliances Wired Equipment Wired
Home Range Temporary Service >.
Duplex Water Heater Electric Heating
Apt. Building Dryer Load Management
CommJlndustrial Fumace Other (Specify)
Farm Air Conditioner
Olher (specify) Comracror's Remarks:
Compute Inspection Fee Below:27 T
# Other Fee Service n ance Size Fee # Circuits/Feeders Fee
Swimming Pool D to 200 Amps 0 to 100 Amps
Transformer Above 200 Amps Above 100 _Amps
S19n5 Inspecror's Use Only: TOTAL
Irrigation Booms
Special Inspection ?Q
Alarm/Communication THIS INSTALLATION MAY DISCONNECTED IF NOT
Other Fee COMPLETED WITHIN 18 MONTH
I, the Electrical Inspector, hereby
i
i
h Rough-in Deca
nspect
as
certify that the above
on
been made.
Final , `
Date
OFFICE USE ONLV
This request void 16 months fwm
0- -?36
A ?
?-
Req est Date
- ? ^ ? Fre ]n Inspection Required
. rgh
m,?us,?t all inspecMOr when reatly)
?Yes ? No Inspection Other ThaRough-In
? qeady Now ? will Notify Inspecbr
Oate Ready
I S!f licensed contractor ?owner hereby request inspectio ot abo e electrical work at:
Job Adtlress (Street, 8ox or Route Na.)
1-7 / V T
4 City
N
Section No.
Township Name or No. 7
Range No.
Counry
Owupant (PRINT)
¦? E_ Phone No-
Power Supplier Atltlress
4
s
Electrical Contractor (Company Name)
N
? Conlractor's ucense No-
1 t2
Mailing Address ( ontractor or Owner Making Installation)
S75-no
e akin
Authorize i ature (Contra rlOw
1
slall ion)
Phone Numher
? WILL MC{ MI yTB dg B Room SF1ZBECTFiICITY gEIACCEPTEDI BY REHEQUEST
STATE BOA DT
1821 Uni rsity Ave., 5t Paul, MN 55104 UNLESS PROPER MSPECTION FEE IS
Phone (612) 642-0800 . .. , . 111111111111 . . ENCLOSED.
REQUEST FOR ELECTRICAL INSPECTION
?E`s'-aoooi•os
l? ?! ? Z , Sea inslmctions for completing ihis form on 6ack of yellow copy.
1
'"X" Below Work;,'`vered by This Request
Ne Add Rep. Type of Building *AWWired Equipment Wired
Home Range Temporary Service
Duplex Water Heater Electric Heating
Apt. Building Dryer Load Management
Comm./lndustrial Furnace Other (Specity)
Farm Air Conditioner
Other (speoifijj CorrtracroTS Remarks:
Compute Inspection Fee Below: A$goV 3 4.w ?
# Other Fee # Service En[ra ce Size Fee # Circuits/Feeders Fee
Swimming Pool 0 to 200 Amps 0 to 100 Amps
Transformers Above 200 Amps Above 100 _Amps
Signs Inspecmr's Use Onry TOTAL
Irrigation Booms Q . (J()
O
?
S ecial Inspection ?
Alarm/Communication THIS INSTl1LLATION MAY BE ORDERED DISCONNECTED IF NOT
ther Fee ? COMPLETED WITHIN 78 MONTHS.
I, the Elecirical Inspector, hereby
i
ti
h
lf
th
h
b Rough-in ?'7e ?i , _ iel?(„f
nspec
on
as
cert
y
ove
at t
e a
been made.
Final ?' i?N 1
Date _ ry ?
„is
OPFICE USE ONLY , e '? This requesl vaid 18 moNhs from
6?16 F 7 4 6 -4
Jj,
19
--c- / a?s
Request Da[e
2- `? ? Fir o. Rough-In Inspection Required
(YOU m,-us,?t all inspector when reatly)
?[{ Yes ? No Inspedion Other Than Rough-In
? Ready Now ? Will Nolify Inspector
Date Ready
I P'f ensed contractor ? owner hereby request inspection oi above electrical work at:
Job Address (Street, Boz or Route No.)
?
1-7 Li City
Section No. Township Name or No. Range No. County
Occupant (PRINn ^
(n ? Phone No.
Power Supplier Address
ElecMCal Contracror (Company Name) Coniractor's License No.
Mailing Address (Contractor or Owner Making Inslallation)
Authorized 5 aWre (ContractodOwner king I siallali j Phone Number
? II?II .?I II II I.I (I II I III III I?I I I I III) UN ESS PDROP ER INSPECTION POEE IS
GrN19Unrversry Ave. SR Pm SMNe% ?10q ICIfY T
Phone (612) 642-0600 O
? ^?/ ? r '7/L? ;EQUEST FOR ELECTRICAL INSPECTION =-
EB-ooooi-os
?? r See instmclions for compleling [his form on back ot yellow copy. ??j h/_ ?j
.c. •r v.
? G?,?(p 95- "X" Below W?rk Covered by This Request
Ne Add Rep. Type of Building Appliances Wired Equipment Wired
Home Range Temporary Service
Duplex Water Heater Electric Heating
Apt. Building Dryer Load Management
Comm./Industrial Fumace Other (Specify)
Farm Air Conditioner
Other (specily) Contrador's Femarks:
Compute Inspection Fee Belaw: 27-7 v3
# Other Fee # Service Entra e Size Fee # Circuits/Feeders Fee
Swimming Pool 0 to 200 Amps 0 to 100 Amps
Transformers , Above 200 Amps A6o 0 Amps
$I f15 Inspector's Use Only: OTAL
Irrigation Booms JV_
Special Inspection
AlarmlCommunication THIS INSTALLATION MAY BE ORDERED DISCON ECTED IF NOT
i? other Fee COMPLETED WITHIN 18 MONTHS. (
I, the Electrical Inspector, hereby
ti
h
h
i Ro°9h-'"
?
on
e above
nspec
as
certify that t
heen made
. Final qate
OFFICE USE ONLY
l
This request void 18 months trom
?43 r
0_ ? ? ? 5i?? ?
1
/
? ?.
Reque Date-- Fire N o. Rough-In Inspection ReqUired Inspeclion Other Than Rough-In
?
1 G ` I (You inspeclor when reatly)
must II
?
? ? Reatly Now E] Will Notily Inspector
s
No Date Reatly
I licensed contractor ?owner hereby request inspection of above electrical work at:
Job Atltlress (SlreeC eox or Route No.) Chy
u
Sec6on No. Township Name or No_ Rge
an o.
County
p ?o
OccupaM (PRINT) Phone No.
S;L
Power Supplier Address
P_ft E&E
s r-
Electrical Contraclor (COmpany Name) Contractor's License No.
" t C_ D 03?
Mailing Address (Contractor or Owner Making Installation)
Authorize gnature (ContraclodOwn r akin sta ion) . Phone Number
M E 7A 57ATE BOAHD OF E ECTRIqTY
I THIS INSPECTION REQUEST WILL NOT
gg idway Bldg. - Room 5-128 11 1 I I I I ?I I( I I? II I I
? II III II II BE ACCEPTED BY THE STA7E BOARD
1821 UniversiTy Ave., St. Paul, MN 55104 ? UNLESS PROPER INSPECTION FEE IS
Phone 16121 642-08U0 .
a?. . . .. ENCLOSED.
I6 a,, 7 3 7 REQUEST FOR ELECTRICAL INSPECTION ?K - ee-ooooi-os
? , See instructlons for completing this form on back of yellow copy. ?D
"X" Below Wq,rk-G?i by This Request ?
Ne Add Rep. Type of Building Appliances Wired Equipment Wired
Home Range Temporary Service
Duplex Water Heater Electric Heating
Apt. Building Dryer Load Management
Comm./Industrial Furnace Other (Specify)
Farm Air Conditioner
Othar (specify) Contreclor's Pemarks?
Compute lnspection Fee Below: 3
# Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Swimmin Pool J 0 to 200 Amps 0 to 100 Amps
Transformers 57. Above 200 Amps Above 100 _Amps
SI f1S Inspector's Use Only: TOTAL
Irrigation Booms P
?/ ?-
Special Inspection ?S?
Alarm/Communication THIS INSTALLATION MAY BE ORDE DISCONNECTED IF NOT
ther Fee ,S COMPLETED WITHIN 18 MONTHS.
I, Ih0 Electrical Inspector, hereby
cedify that the above inspection has
been made. Rough-in / r
Fnai t Datef/?7/p
{
ale
f ? -?
OFFICE l1SE ONLY
This requesl vold 18 mon[hs irom
soar?
5 LA.
9??
0 a
?
Req st Dale Fire N. R gh-ln InspecNon Fiequiretl Ins ction Other Than Rough-in
-? '? ? (YOU must II inspec[or when ready) ?Ready Now ? Will Nolify Inspector
Yes ? N. Date Read
IRlicensed contractor ? owner hereby request inspection of above electrical work at:
Job AdtlresS (Straet, Box of Route Na.) Ciry
?
Seciion No. Township Name or No. Range No. Counry
Occupant (PRINT) Phone No.
A. 5
Power Supplief Address
? sr
Electrical Contraclor (Company Name) Contraclor's License No.
0
Mailing Adtlress (Conimctor or Owner Meking Installation)
73
Authorized VViature (Gontrac or ner Making Install -on) . Phone Number
o B
i 'TM
'
THIS
I
DT
B
e
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