P - 83665REQUEST FOR ELECTRICAL INSPECTION
I II IIIII IIIII IIIII IIIII IIIII IIIII IIII III) 1^g21eUn vess ty Ave. rRmf SI 128cSt. Paul, MN 55104
* 0 3 6 3 2 6 9 2* Phone(612)642-0800
Home Duplex Apt. Bldg. Other: New
�ommercial Industrial Farm Remc
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
SAVER'S SWITCH INSTALLATION
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Calculate Inspection Fee - This Inspection Request will noi be accepted withoui 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. �1'
Alarm/Remote Control
Swimming Pool I hereby certify that I inspected the elechical installation described herein on the dates stated
Irrigation Boom Rougn-in . oate
X Speciallnspection 1 . 00
Final � Date
Investigative Fe ; � _..--� -____ _.-- � _ F
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validation date printed in this box.
363-269�] �
/J `�� �� �� � H NUMBER �9706000
PLEASE PRINT OR TYPE
Rough-in inspection required? ❑ Yes ❑nlo Inspection Other Than Rough-In: [�( Ready Now ❑ Will Call
(You must call the inspector when ready) Date Ready: %� �, %� 97
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at
Job Address (Street, Box, or Route No. Cit Zip Code
05477 E$R�NNER PAS F�?IDLEY 55432
Section No. � Township Name or No.
Occupant
DEBRA RAE
Power Supplier
NSP
Electrical Contractor (Company Name)
Range No. Fire No. County
Phone No.
DE BRUZ2I
Address
KPLS OFF'ICE
Conhactor License No.
Mailing Address (Contractor or Owner Performing Installation)
Performing Installation)
ANOKA
SB6-9871
EB-00001A-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY
Master Lic. No. (Plant Elect. Only)
Phone No.