P - 83078�, i��II �IIII IIIII IIII) IIIII IIII) IIIII IIIII IIII IIII M$ n� UE a SsaO Bo LR � SR 1C8 StNPaPEMN 5O5N04 � ����
' * 0 3 8 6 9 2 9 4* Phone (612) 642-0800 �����
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Cond. Htg. Equip. Water Htr. oad Mgmt. Other:
Dryer Range Elec. Heat emp. Service
"X" above the work covered by ihis request Enter remarks in this space and on the back of the white copy only.
SAVER'S SWITCH IHSTALLATION
Calculate Inspection Fee - This Insoection Request will not be accepted without the carect 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. 15. Q!
Alarm/Remote Control
Swimming Pool � �� w I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom r Rougn-io Date
peciallnspection 15.0 c�
Investigative Fee � � �� / �
THIS INSTALLATION MAY BE ORDERED DISCONNEC7'ED IF NOT COMPLETED WITHIN 18 MONTHS.
� OFFICE USE ONLY This request void 18 months from validation date printed in this box.
386-929 4 • �� �
5�i�
JOB NUMBER #970600
PLEASE PRINT OR TYPE
Request Da� � 1�4 � 9$ Rough-in inspection required? ❑ Yes ❑ Nox Inspection Other Than Rough-In: ❑ 4�ady Now 0 Will Call
(YOU must call the inspector when ready) Date Ready:
I, ❑�censed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
05917 4TH ST NE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
AN�KA
Occupant Phone No.
RICHARD LEE CERMAK 5'74-9610
Power Supplier Address
Electrical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Only)
Mailing Address (Contractor or Owner Performing Installation)
Authorize Signat ( actor or Owner erforming Insta ion " i Phone No.
,c� (j r
EB-00001A-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY