P - 84040I I�I�II IIIII IIIII �IIII IIIII IIIII IIIII IIIII IIII IIII Mg � uoia SSaO B aLRm. SR1C8, St PaPEMN 5O5N04
* 0 3 7 1 6 7 4 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 Temp. Service
C" above the work covered by this request. Enter remarks in this space and on the back of the white cqoy only.
SAVER'S SWITCH INSTALLATION
��
� c�
�:��'" :
Addn
Repair
Calculate lnspection Fee - This ln�oection 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. i 5. 50
Alarm/Remote
Swimming Pool I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In oace
}{ Special Inspection 1 . S0 '
Final
Investigative Fee � �-.�--- °a _ Z _��
_YTHIS 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.
371-674 �
��. p_ / 5', SZ�
�`� JOB NUMBER �9706000
PLEASE PRINT OR TYPE
Requ�1.61ate1.7 � 9.� Rough-in inspection required? ❑ Yes ❑�lo Inspection Other Than Rough-In: [� Ready Now ❑ Will Call
VJ
(You must call the inspector when ready) Date Ready: 10 � 17 � 97
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
07651 BRIGADOON PL NE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
Occupant
Power Supplier
Address
AxoxA
Phone No.
Electrical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Only)
Mailing Address (Contractor or Owner Performing Insta lation)
Au o i ature ontrac or or wner Per orming ns a a ion � Phone No.
5"
EB-00001 -1 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY ,