P - 83712� REQUEST FOR ELECTRICAL WSPECTION ���
I � I I�I�II I��II IIII) IIIII IIIII IIIII IIII) IIIII IIII IIII 1n821eUni eSs ty A earRmf SI 128cSt. Paul, MN 55104 ��.- �
* 0 3 6 3$ 5 3 3* Phone (612) 642-0800 �'��'
Home Duplex 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 only.
SAVER'S SWITCH INSTALLATION
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
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 `S�'
Sign/Outline Ltg. Xfmr. 15.��'
Alarm/Remote Control
Swimming Pool I hereby certify that I inspected the elechical installation described herein on the dates stated
Irrigation Boom Rough-In Date
}( Speciallnspection 1 . 0Q1 Dat
Final ��_. .�_ Z�
Investigative Fe p• r-
THIS INSTALL I ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS_
_—.---__._--___—__-------------------------------
. OFFICE USE ONLY This request void 1S months from validation date printed in this box.
363-853�] �,,�3� �
����� JOB NUMBER �9706000
PLEASE PRINT OR TYPE
Request�a� 17 � 97 Rough-in inspection required? ❑ Yes �lo Inspection Other Than Rough-In: [� Ready Now ❑ Will Call
(You must call the inspector when ready) Date Ready: 7� � 7� C�']
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
01436 ROYAL OAK CT NE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
Occupant
Power Supplier I Address
ANOKA
Phone No.
t'.AF. —
Electrical Contractor (Company Name) Contractor License No. I Master Lic. No. (Plant Elect. Only)
ress (Contractor or
Phone No.
71 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY