P - 84059REQUEST FOR ELECTRICAL INSPECTION ���
III��II�IIIIIIIIIIIIIIIIIIIIIIIIIII�IIIIIIIIIIIIII 1^g2leUni essty A earRmf SI 128cSt. Paul, MN 55104 � �'
* * Phone (612) 642-0800 �"�=�
03716982
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
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 this space and on the back of the white cqoy only.
SAVEk'S SWITCH INSTALLATION
Calculate Inspection Fee - This Inspection Requesi will not be accepted without the conecf 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
Swimmin P `
9 '�' I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Ro�9n-ir, Date
X Special Inspection 1. StZ!
Final • Dat - q
Investigative Fee ' �� / �
�_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.
371-698 ?� � f� �
� ���
JOB NUMBER #97060Q10
PLEASE PRINT OR TYPE
Requs6t.9a� 1.7 � 9.7 Rough-in inspection required? ❑ Yes ❑XJo Inspection Other Than Rough-In: [� Ready Now ❑ Will Call
i YJ
(You must call the inspector when ready) Date Ready: 10I 1% I 9%
I, �f licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
�16941 HICKORY DR NE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
Occupant
ROGER C� WILSOM
Power Supplier Address
ANOKA
Phone No.
rJ%1—�1.�J1
Electrical Contractor (Company Name) I Contractor License No. I Master Lia No. (Plant Elect. Only)
Mailing Address (Contractor or Owner Performing I
or
c
8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON §ALfi dF'YELLOW COPY
Phone