P - 84121I t I IIIII�IIII IIII) IIIII IIIII IIIII IIIII IIIII IIII IIII M$ n� UE a SsatOe B e LR of S�I 1cCt$cs{N aPEMN ION04
* 0 3 7 7 6 6 5 1 * 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. Hea# Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
SAVEFt'S SWITCH INSTALLATIOH
Addn
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 ONLY TOTAL
Sign/Outline Ltg. Xfmr. 1'r...1' . 50
Alarm/Remote Control
Swimming Po '� I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rougn-in oate
Special Inspection
Final � �?�-- �
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.
371-665 [� � ��s-a
� ��H y JOB NUMBER #9706000
PLEASE PRINT OR TYPE
Requ�1�� 1'� ��'� Rough-in inspection required? ❑ Yes �(Vo Inspection Other Than Rough-In: [� Ready Now ❑ Will Call
(YOU must call the inspector when ready) Date Ready: 1, QJ I 1% I 9%
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
01444 ?6TH AVE NE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
AHOKA
Occupant Phone No.
VARGHESE MATHAI 783-0080
Power Supplier Address
N5P MPLS OFFICE
Electrical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Only)
Mailing Address (Contractor or Owner Performing Installation)
Auth i n re (Contractor or Owner Performing Installation) Phone No.
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EB-00001A-11 8 5 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY