P - 84086'� I' REQUEST FOR ELECTRICAL INSPECTION ��,,
II �� I 11I��� IIIII IIIII IIIII IIIII IIIII IIIII IIIII (III IIII 1ng21 Un veS ity A earRmf SI 128cISt. Paul, MN 55104 ��. �
* 0 3 7 1 6 3 1 3* Phone (612) 642-0800 "''°� '
Home Dupiex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
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 oniy.
SAVER'S SWITCH IHSTALLATION
Calculate Inspeciion Fee - This Inspection Request will not be accepted without the correct fee:
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 Am
Fee
Transformer/Generator INSPECTOR'S USE ONLV TOTAL
Sign/Outline Ltg. Xfmr. 15. 50
Alarm/Remote Control
Swimming Pool I hereby certifv that I inspected the electrical installation described herein on the dates stated
Irrigation Boo � Rough-In
X Special Inspection 1. S0
Final
Investigative Fee
THIS INSTALLATION MAY BE ORDERED
371-631 [�
Date
- i. Z -� �
D ONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONIY This request void 18 months from validation date printed in this box.
�.� /�;�
���� JOB NUMBER #9706000
PLEASE PRiNT OR TYPE
Reque�t8a�1.7 /�7 Rough-in inspection required? ❑ Yes ❑KJo Inspection Other Than Rough-In: [� Ready Now ❑ Will Call
1 YJ
(You must call the inspector when ready) Date Ready: � A� � 7� Cj7
I, $] licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
00�71 RICE CREEK WAY HE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
Occupant
GREGORY I
Power Supplier
Electrical Contracror (Company Name)
Mailing Address (Contractor or Owner Performing
8/95
FARMER
Address
AHOKA
Phone No.
571-6062
Contractor License No.
or c�wner rertoy�inp� staua,nYo�n��
I�A YJ � i! � �4''�'_
STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY
Master Lic. No. (Plant Elect. Only)
Phone No.