P - 83652� � I REQUEST FOR ELECTRICAL INSPECTION
�i .� I�I�I�IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII�III Mg2leUnivessty A earRmf SI 128cSt. Paul, MN 55104
* 0 3 6 3 9 5 7 2�` Phone (612) 642-0800
Home , Duplex Apt. Bldg. Other: New
Commerciai Industriai Farm Remod
Air Cond. Htg. Equip. Water Htr. X Load Mgmt. Other:
Dryer Range Elec. Heat emp. Service
"X" above the work covered by this request. Enter remarks in this space and on the back of the white cqoy only.
SAVER'S SWITCH INSTALLATION
Calculate Inspection Fee - This Inspection Request will not be accepied withouf the correct tee:
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_Amps Above 100 Am
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Addn
Transformer/Generator INSPECTOR'S USE ONLV TOTAL
Sign/Outline Ltg. Xfmr. 15 �
Alarm/Remote Control
wimming Pool I hereby certify that I inspected the electrical installation described herein on the dates stated
Irriaation Boom Rough-In Date
Fee
�pecr t' e� wi t . v�r� �_'�; I p� ��9 p
Final Q
nvesti l
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
' T- � � OFFICE USE ONLY This request void 18 months from validation date printed in this box.
363-957 �] ��•
/�� SU` � � � JOB NUMBER #�9706000
PLEASE PRINT OR TYPE
Request'Qa� 1'� � C�? Rough-in inspection required? ❑ Yes �{JO Inspection Other Than Rough-In: [
(You must call the inspector when ready) Date Ready:
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City
07835 ALDEN WAY NE FRIDLEY
Section No. Township Name or No. Range No. Fire No. County
ANOKA
Occupant
WILLIAI'[ F
Power Supplier
Electrical Contractor (Company Name)
Mailing Address (Contractor or Owner Performing
STEVENS
Address
Phone No.
� OFFICE
Contractor License No.
Ready Now ❑ Will Call
7/17/97
Zip Code
55432
574-0551
Master Lic. No. (Plant Elect. Only)
Auth � d Signat (Contractor r Owner Performing Installation) Phone No.
2� .
EB-00001A-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY