P - 83677i REQUEST FOR ELECTRICAL INSPECTION �,,����
� III{�II�II(�IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII 1�g21 Unvess'ty A earRmf SI 128cISt. Paul, MN 55104 �,�.���,
'* 0 3 6 3 8 6 1 6* Phone(612)642-0800
New Addn
Home Duplex Apt. Bldg. Other: Remod Repair
Commercial Industrial Farm
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 INSTALLATION
�late Inspeciion Fee - This Inspection Request will not be accepted without the correct tee: Fee
Other Fee
# Service Entrance Size Fee # Circuits/Feeders
0 to 200 Amps 0 to 100 Amps
Mobile Home Park Stall Above 100 Amps
Street Ltg./Traffic Sig. Above 200 Amps �
TOTAL „
Transformer/Generator INSPECTOR'S USE ONLY 15. �
Sign/Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool I hereby certify that I inspected the electrical installation described herein o Date dates stated
Irriaation Boom Rough-In
Investigative F�§t�j�'!
THIS INSTALLATION
363-861 �
>._^'- i �a� — Z � ^�
Final . , �� ,...
ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
^ � OFFICE USE ONLY This request void 1S months from validation date printed In this box.
� ��� !
�� �� JOB NUI�lBER �l9706000
PLEASE PRINT OR TYPE �j Inspection Other Than Rough-In: d
Request'�afE 1"� � 97 Rough-in Inspection required? ❑ Yes o
(You must call the inspector when ready)
Date Ready:
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
City
Job Address (Street, Box, or Route No.) FRIDLEY
00100 HORIZON CIR NE
Fire No. County
Section No. Township Name or No.
Range No. AN�KA
IPhone No.
Occupant
DALE H
Power Supplier
Electrical Contractor (Company Name)
Mailing Address (Contractor or Owner Performing
LARSON
Address
STATE BOARD COPY - SEE
Contractor License No.
Ready Now ❑ Will Call
7/17/97
Zlp Code
55421
572-1940
fIONS ON BACK OF YELLOW COPY
Master Lic. No. (Plant Elect. Only)
Phone No.