P - 84044! � I�I�II IIIII (IIII IIIII IIII) IIIII IIIII IIII) IIII IIII M$ n� Uo a SsatOe B aLR o SR 1C8 StN aPEMN ION04
* 0 3 7 1 6 2 9 7* Phone (612) 642-0800
Home Duplex Apt. Bldg. Other: New
Commercial Industrial Farm Remod
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
I°X" 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
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Addn
Calculate In�oection Fee - This Inspection Request will not be accepted without the conect 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. 50
Alarm/Remote Control
Swimmin Po �
9 �� � I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In Date
Special Inspection
Final �ate� , ��
Investigative Fee °`�—'--� a
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.
371-629 [� � � Jr,�
� 1�N�5
JOB NUAIBER #9706000
PLEASE PRINT OR TYPE
Reque�t�ayE 1'7 f G�7 Rough-in inspection required? ❑ Yes �Jo Inspection Other Than Rough-In: � Ready Now ❑ Will Call
(You must call the inspector when ready) Date Ready: 10 � 17 � C37
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sheet, Box, or Route No.) City Zip Code
07401 CONCERTO CURV FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
Occupant
DAVID
Power Supplier
Electrical Contractor (Company Name)
ANOKA
Phone No.
CLUELOW 785-7931
Address
Mailing Address (Contractor or Owner Performing Installation)
Contractor License No. � Master Lic. No. (Plant Elect. Only)
iature (Contractor or Owner Performing Installation) Phone No.
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5 �� � -�4� „�,^
8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY