P - 83690� REQUEST FOR ELECTRICAL INSPECTION
II " I�I�IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII 1ng21eUniveSsty A earRmf SI 128cSt. Paul, MN 55104
* 0 3 6 3 8 5 5 8* Phone(612)642-0800
Home Duplex Apt. Bldg. Other: New
Commercial Industrial Farm Remod
� 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
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Addn
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct tee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders
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 �"
Alarm/Remote Control
Swimming Pool I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In Date
1
THIS INSTALI
363-855
Fee
0
.
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_ BE_ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS. �
OFFICE USE ONLY This request void 18 months from validation date printed in this box.
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JOB NUMBER #9706000
PLEASE PRINT OR TYPE
Request�aye 17 ��^� Rough-in inspection required? ❑ Yes [�Jo Inspection Other Than Rough-In: [K Ready Now ❑ Will Call
(You must call the inspector when ready) Date Ready: '� � 1'� � C�'�
I, �l'] licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) Ciry Zip Code
0?351 MELODY DR HE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
Occupant
DALE J
Power Supplier
Electrical Contractor (Company Name)
Mailing Address (Contractor or Owner Performing
or
ANOKA
Phone No.
KUKIELKA
Address
KPLS OE'F'ICE
Contractor License No.
dlation)
AVAGE KN. 55376
i Installation)
%BS-%82.1
-11 8/9 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY
Master Lic. No. (Plant Elect. Only)
Phone No.