P - 82659I��! � I 19I I� III �I III II III II III II III II III II III I IIII 821�Uni es iaOAv a Rm� S-�iCBASt.' PaulP, MNT55O104 �����'
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Home Duplex Apt. Bldg. Other. New Addn
X Commercial Industrial Farm NUY'Slrig Home Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other.
Dryer Ran e Elec. Heat Temp. Service
"k' above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
Temperature Control Wiring
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Olher Fee # Service Enirance Size Fee # Circuils/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic $ig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR�suseoN�r TOTAL
Sign/Outline Ltg. Xfmr. �
Alarm/Remote Control
Swimming Pool
I hareb ceAi that I ins ecfed }he eledncal installation described herein on the dates stated
Irrig6tion Boom Rough-In Dare
Special Inspecf
Final �a
Investigative Fee �—J "�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
3��— 2 81 �] OFFICE USE ONLY This request void 18 monfhs from validation date priNed in }his box.
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PLEASE PRINT OR TYPE
Requesf Date Rough-in inspecfion requiredZ � Yes � No Inspecfion Other Tfian Rough-In: � Ready Now � Will Call
7�-"� - 9 6 (You must call }he inspedor when ready� Date Ready:
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (5}reet, Box, or Route No.) Ciy � Zip Code
7590 N.E. Lyric Lane Fridley 55432
Sedion No. Township Name or No. Range No. Fire No. County �
Anoka
Occupant Phone No.
Fridley Nursing Home
Power Supplier Address
Elecfrical Contrador (Company Name) Contrador License No. � Master Lic. No. (Plant Eled. Only)
Uhl Company, Inc. CAO`�856
Mailing Address (ContratTor or Owner Performing Installation)
P•�• Box �+38, Maple Grove MN 55369
AuMorized Signature (Contmdor or Owner Performing Insfallation, � 4 g 5 � Pho���
`������� � 5-7226
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