P - 83716i
; I REQUEST FOR ELECTRICAL INSPECTION ����
fI�III��IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII 1n821 Uni essty A earRmf SI 128 St. Paul, MN 55104 ��- �
� * 0 3 6 3 2 4 1 1* 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 Inspeciion Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stali 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 ,,,sC?
Sign/Outline Ltg. Xfmr. 15. e�
Alarm/Remote Control
Swimming Pool I hereby certify that I inspected the electrical installation described herein on the dates stated
Irriaation Boom Rough-In Date
Special Inspection
Investigative Fe�
THIS INSTALLATION
Final
ORDERED DISCO�NE�D IF NOT COMPLETED WITHIN 18 MONTHS.
� OFFICE USE ONLV This request void 18 months from validation date printed in this box.
363-241 � � ��� �
��� �� JOB NU?1BER �9706000
PLEASE PRINT OR TYPE
Request Rough-in inspection required? ❑ Yes o Inspection Other Than Rough-In: Ready Now ❑ Will Call
(You must call the inspector when ready) Date Ready: %� 1%� 97
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route NoJ City Zip Code
06230 STINSON HLV FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
AHOKA
Occupant
MARK T
Power Supplier
NSP
Electrical Contractor (Company Name)
Mailing Address (Contractor or Owner Performing
Phone No.
BERNARD
Address
!lPL.S OFPICE
Contractor License No.
57' 1-7260
Master Lic. No. (Plant Elect. Only)
3ignat re ontract r Owner Performing Installatiq� � Phone No.
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11 /95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY