P - 84087I � I IIIII REQUEST FOR ELECTRICAL INSPECTION �,��
III���IIIIIIIIIIIIIIIIIII�IIIIIIIIII�IIIII II 1^821eUnivess ty A earRmf S1e 28ciSt. Paul, MN 55104 ��.���_
` * 0 3 7 1 6 4 3 8* Phone (612) 642-0800 -
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Cond. Htg. Equip. Water Htr. }{ Load Mgmt. Other:
Dryer Range Elec. Heat emp. 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 INSTALLATIOH
Calculate Ins,oection Fee - This Inspection Request will not be accepted without the conect 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 ONLY TOTAL
Sign/Outline Ltg. Xfmr. 1S. 50
Alarm/Remote Control
Swimming Poo �l I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boo y) i) Rough-In Date
Speciai Inspection 1 0 Finai — °_� �,�
r�
Investigative Fee
_ THIS INSTALLATION MAY BE ORDERED DISCON__ CTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validation date printed in this box.
371-643 [�
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JC1B HUMBER �9706000
PLEASE PRINT OR TYPE
Requgst,4a�1,7 � 9•7 Rough-in inspection required? ❑ Yes []yJo Inspection Other Than Rough-In: f�b Ready Now ❑ Will Call
110 � �i
(You must call the inspector when ready) Date Ready:
I, �j,] licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
00136 kIVER EDGE WAY NE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
Occupant
Power Supplier
Contractor (Company Name)
I Phone No.
ARLANDER
Address
Contractor License No.
[ion
sa �
� — -
11�/95 STATE BOARD COPY - SE�NSTRUCTIONS ON BACK OF YELLOW
Master Lic. No. (Plant Elect. Only)
Phone No.