P - 84103�II�II��IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII 1n82�1 U�iverst0 B aLR� SR1C8 St PauPIEMN 5O5N04
* 0 3 7 1 6 9 2 5* Phone (612) 642-0800
Home Duplex Apt. Bldg. Other: New
Commercial Industrial Farm Remc
Air Cond. Htg. Equip. Water Htr. 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
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Addn
Repair
Calculaie Inspection Fee - This Inspection Request will not be accepted wiihout 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
Sign/Outline Ltg. Xfmr. 1rJ. 50
Alarm/Remote Control
Swimming P �� , I hereby certify that I inspected the elechical installation described herein on the dates stated
Irrigation Boom 'v Rough-In Date
K Speciallnspection 1 . 50
Final Date �
Investigative Fee ��_. �
_ THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHI 18 MONTHS.
_ .f . ��-�_. . . . ,
---------- --- — ----- - -- ------ --
- -- --- --- ---
OFFICE USE ONLY This request void 18 months from validation date printed in this box.
371-692 � /� � �
,� ��qs �
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JOH NUMHER #9706000
PLEASE PRINT OR TYPE
Reque6L61at� 1.7 � 9.7 Rough-in inspection required? ❑ Yes ❑XJo Inspection Other Than Rough-In: [� Ready Now ❑ Will Call
1 �ll
(You must call the inspector when ready) Date Ready: ��� �.7 ��.�
I, �] licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
04856 3RD ST NE FRIDLEY 55421
Section No. Township Name or No. Range No. Fire No. County
Occupant
TERRY J SMOL
Power Supplier Address
�P
Electrical Contractor (Company Name)
Mailing Address (Contractor or Owner Performinq Insta lation)
Contractor License No.
nxoKA
Phone No.
571-1820
8/95 STATE BOARD COPY - SE�INSFROC1�10Ty�„ON BACK OF YELLOW COPY
Master Lic. No. (Plant Elect. Only)
No.