P - 83316REQUEST FOR ELECTRICAL INSPECTION
��.J !J � O� l,J � 8121eUnivers ty A ear Rm. S-128,'St. Paul, fNN 55104
� Phone(612) 642-0800
X Home Duplex Apt. Bldg. Other: New
Commercial Industrial Farm Remod
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in ihis space and on the back of the white copy
Upgrade wiring/ addition of smoke alarms, etc
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Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
Sican/Oudine Lta. Xfmr. 20 . 50
Swimming Pool
I hereb certi that I ins the electrical installafion deuribed herein on fhe dafes stated
Irriqation Boom e,,.,,,�., n„b
Fee
Investigative Fee U� GJ — 0
THIS INSTALLA ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This requesf void 18 monfhs kom validafion dafe prinfed in this box.
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* 0 6 9 0 0 2 0 3* D��
9 8 0 6 2� PLEASE PRINT OR TYPE. �
Request Dafe Rough-in inspection requiredT ❑ Yes ❑ No Inspection Ofher Than Rough-In: ❑ Ready Now ❑ Will Call
10 / 15 / 9 8 (You must call the inspecfor when ready) Dafe Ready:
I, �licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Addreu �Shcef, Box, or Roule No.� City Zip Code
601 58th Ave NE Fridley
Secfion No. Townshio Name or No. Ranae No. Fire No_ Counlv
Ano�a
Occupant � � Phone No.
Ed & Joan Marciniak 571-6803
Eleclrical Conkacror �Company Name) ConhaMor License No. Masier Lic. No. (Plant Elect. f
Amrican Eagle Electric, Inc. CA00161
Mailing Address �Conhacior or Owner Performing Installation)
18475 Rum River Blvd 1VW, ANoka, MN 55303
Authwized Signa e(Conkacfor or Owner Performing Installation� Phone No.
� �6583 753-0438
E&00001 A-1 1 8/96 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY