P - 83731IIIII�IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII M82�j U�niv SstyOAve.LRm. SRiC8, St PaPEMN 5O5N04
�* 0 3 6 3 3 4 1 9* Phone(612)642-0800
Home Duplex Apt. Bldg. Other: New
Commercial Industrial Farm Remc
Air Cond. Htg. Equip. Water Htr. }C 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
Calculate Inspection Fee - This lnspection 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. 1S 8�
Alarm/Remote Control
Swimming P I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Bo < < Rough-In Date
}{ Speciallnspection i . Ia0 ^�`�
Final p
Investigative Fee
�'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.
363-341 �
/5.50 � �3 ��
JOB NUI78ER #�9706000
PLEASE PRINT OR TYPE
Rough-in inspection required? ❑ Yes �{Jo 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 No.) Ciry Zip Code
07574 5TH ST NE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
ANOKA
Occupant Phone No.
BRUGE K KIVI 7B6-3246
Power Supplier Address
NSP liPLS OF'FICE
Electrical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elect Only)
Mailing Address (Contractor or Owner Performing
r+uinorize��gnawre �c tracror U ner Neriorming Installation) Phone No.
/fi►' �/�;,r; ,`� � � �� �) �.4� ��
� .Y// Y/
I�� EB-00001A-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY
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