P - 84100I I��III IIIII IIIII IIIII IIIII IIII) IIII) IIIII IIII IIII M8 n�eso a Ssty� B e.LRm. SR 1 8 LStNS PEMN ION04 ����� .
* * Phone (612) 642-0800 �`"�'�
n��y�12�
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 fhis space and on the back of the white copy only.
SAVER'S SWITCH IHSTALLATION
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 ONLV TOTAL
Sign/Outline Ltg. Xfmr. 1`�J. 50
Alarm/Remote Control
Swimmin Po `� "
9 F I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rougn-in Date
}{ Special Inspection 1, 5 oa
Final /
Investigative Fee -�-�----- ��� C �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
-------------------- - �
OFFICE USE ONLY This request void 18 months from validation date printed in this box. �
371-612 � f��
� ���9�.�
JOB HUMBER #9706000
PLEASE PRINT OR TYPE
Requ�t,f�a�1,7 / 9,7 Rough-in inspection required? ❑ Yes IlPlo Inspection Other Than Rough-In: falr Ready Now ❑ Will Call
I[J A �t
(You must call the inspector when ready) Date Ready:
I, $] licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
04539 2 1/2 ST NE FRIDLEY 55421
Section No. Township Name or No. Range No. Fire No. County
ANOKA
Occupant Phone No.
JOSEPH L AWE 244-2162
Power Supplier Address
Electrical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Only)
Mailing A dress ontractor or Owner er orming Inst lation)
Au n tu o Pe An s a ' Phone No.
� ���
EB-00001 1 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY