P - 84045i i REQUEST FOR ELECTRICAL INSPECTION ��,
,� I��IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII�IIIIIIIIIIIII 1ng21eUnl eSsty A earRmf S1e28CSt. Paul, MN 55104 �.o, �',
* 0 3 7 1 6 3 3 9* Phone (612) 642-0800 �"°�'"
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Cond. Htg. Equip. Water Htr. X Load Mgmt. Other:
Dryer Range 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.
SAVER'S SWITCH INSTALLATIOH
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 ONLY TOTAL
Sign/Outline Ltg. Xfmr. 15. 50
Alarm/Remote Control
Swimming P �/ � I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boo �� Rough-In Date
X Speciallnspection 1 . 50
Final Date
Investigative Fee �—��
THIS INSTALLATION MAY BE ORDERED DISC NECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validation date printed in this box.
371-633 �
� / 5, so !
`� ��� JOH NUMBER #9706000
PLEASE PRINT OR TYPE
Reque61Aa�1.7 � 9.7 Rough-in inspection required? ❑ Yes ❑xJo Inspection Other Than Rough-In: [� Ready Now ❑ Will Call
1 YJ
(YOU must call the inspector when ready) Date Ready: i 0 I i% I g%
I, $] licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
07419 CONCERTO CURV FFtIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
Occupant
Power Supplier � Address
A
Phone No.
Electrical Contractor (Company Name) rContractor License No. I Master Lic. No. (Plant Elect. Only)
Mailing Address (Contractor or Owner Performing
iqnature ( ontrac or or wner Pe�%�ming�nsiaOationr Phone No.
I �� �'y�'-� r�e • a.f� n
1 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY