P - 83468I `' I I�II�IIII IIII) (IIII IIII� IIIII (IIII IIIII IIII IIII ME n�esota S atOe B aLd of EReCAL �NSPECTION
1821 University Ave., Rm. S 128, St. Paul, MN 55104
* 0 3 7 8 9 Q 1 3* Phone(612)642-0800
Home Duplex Apt. Bldg. Other: New
Commercial Industrial Farm Remo
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat emp. 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
Calculate lnspection Fee - This Inspection Request will not be accepied 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
Sign/Outline Ltg. Xfmr. 15. 50
Alarm/Re r
Swimming Poo ~ I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In oate
}C Speciallnspection 1 .50 �
Investigative Fee Final Date� � �
THIS INSTAL�ATION 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.
378-901�] • �s�
�/�3�
JOB NUMBER #9706000
PLEASE PRINT OR TYPE
Requesr��16 � 9� Rough-in inspection required? ❑ Yes [MJo Inspection Other Than Rough-In: � Ready Now ❑ Will Call
(You must call the inspector when ready) Date Ready: 6I 1 G/ S8
I, $] licensed contractor ❑ owner hereby request inspection ot the above electrical work at:
Job Address (Street, Box, or Route NoJ Ciry Zip Code
05933 4TH ST HE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
Occupant
JEAHNE V HOF'F'AT
Power Supplier Address
NSP MP
Electrical Contractor (Company Name)
�ASTF'R F't.F'f TRT[': C'[]_ , TN["._
Mailing Address (Contractor or Owner Performing Installation)
] 24f,7 RnONE AVF $,. �AVAf,F
Authgwized Siqnature (Contractor or Owner Performina Installafionl
Contractor License No.
ANOKA
Phone No.
574-1232
8/95 STATE BOARD COPY - S� 11RS71{��ONS ON BACK OF YELLOW COPY
Master Lic. No. (Plant Elect. Only)
Phone No.