P - 84072� I � I REGIUEST FOR ELECTRICAL INSPECTION �,��
I �,II�IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII II 1�821eUni essty Ave.rRmf S1e 28CSt. Paul, MN 55104 ��. .�_.
� * 0 3 7 1 6 9 5 8* Phone (612) 642-0800 '�'
I Home Duplex Apt. Bidg. Other: New Addn
Commercial Industrial Farm Remod
Air Cond. Htg. Equip. Water Htr. X Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
above the work covered by this requesi. Enter remarks in this space and on the back of the white copy only.
SAVER'S SWITCH INSTALLATION
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct tee:
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 ONLV TOTAL
Sign/Outline Ltg. Xfmr. 15. 'rJ(a
Alarm/Remote Control
Swimming Pool ly' " I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom �'� Rough-In Date
X Speciallnspection 1. 50 �ac
Investigative Fee Finai �p _ _ 2",- j�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MO THS. -
� ` OFFICE USE ONLY This request void 18 months from validation date printed in this box.
371-695 �
,����9�
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JOB NUMBER #9706000
PLEASE PRINT OR TYPE
Requ�tAa�1,7, g.7 Rough-in inspection required? ❑ Yes flAlo Inspection Other Than Rough-In: la. Ready Now ❑ Will Call
YJ 1C �i
(You must call the inspector when ready) Date Ready: ��� �.� � Q7
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
06311 MADISON ST NE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
ANOKA
Occupant
DIANE
Power Supplier
Electrical Contractor (Company Name)
Mailing Address (Contractor or Owner Performing
I Phone No.
ELCH
Address
MPLS OFFICE
Contractor License No.
8/95 STATE BOARD COPY �SE�'INSiRUCTIONS ON BACK OF YELLOW COPY
Master Lic. No. (Plant Elect. Only)
Phone No.