P - 84033'� RE(�UEST FOR ELECTRICAL INSPECTION
II �II���II�IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII�IIIIII 1^821eUni eSsty A earRmf SI 128cISt. Paul, MN 55104
* 0 3 7 1 6 5 9 4* Phone (612) 642-0800
Home Duplex Apt. Bldg. Other: New
Commercial Industrial Farm Remo�
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 ot the white copy only.
SAVER'S SWITCH INSTALLATIOId
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Addn
Repair
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200_Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLV TOTAL
Sign/Outline Ltg. Xfmr. 15. 50
Alarm/Remote Control
Swimming Pool I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In Date
}{ Speciallnspe 'oa.- . 0 F��ai ,; pace G
Investigative ��� �
THIS WSTALLATION MAY BE O�DERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
� ��- � OFFICE USE ONLV This request void 18 months from validation date printed in this box.
371-659 [�
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"` cG/�� JOB NUMBER #9706000
PLEASE PRINT OR TYPE
Requ�tAa�1.7 � 9.7 Rough-in inspection required? ❑ Yes [J�Jo Inspection Other Than Rough-In: [� Ready Now ❑ Will Call
YJ
(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 NoJ Ciry Zip Code
05455 ALTURA RD NE FRIDLfiY 55421
Section No. Township Name or No. Range No. Fire No. County
Occupant
WALTER
Power Supplier
ACH
Address
ANOKA
Phone No.
5%2'
Electrical Contractor (Company Name) Contractor License No.
Mailing Address (Contractor or Owner Performing Insta lation)
Auth i ature (Contractor or Owner Performing Installation)
r
EB-00001A-1 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY�
Master Lic. No. (Plant Elect. Only)
Phone No.