P - 84039� I I�I�� IIIII IIIII IIIII IIIII IIIII IIIII III�I IIII IIII ME n�esota S atOe B aLd of E�lecCtr��ic tyNSPECTION
«� 1821 University Ave., Rm. S 128, St. Paul, MN 55104
' * 0 3 7 1 6 3 2 1 * Phone(612)642-0800
Home Duplex Apt. Bldg. Other: New
Commercial Industrial Farm Remo
Air Cond. Htg. Equip. Water Htr. X Load Mgmt. Other:
H t em . Service
Dr er Ran e Elec. ea p
Y 9
"X" above the work covered by this request. Enter remarks in this �oace and on the back of the white copy only.
SAVER'S SWITCH INSTALLATION
Calculate In�oection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200_Amps Above 100 Am
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,�'a!u�;�:�
Addn
Fee
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
Sign/Outline Ltg. Xfmr. 15. 50
Alarm/Re ol
Swimming I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In Date
X Speciallnspection 1 . 50
Final Date
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.
371-632 [� �,5� �
�P �'`b��� /
JOB NUMBER �l9706000
PLEASE PRINT OR TYPE
Reque6tAa� 1.7 � 9.7 Rough-in inspection required? ❑ Yes ❑KJo Inspection Other Than Rough-In: 17� Ready Now ❑ Will Call
11[J ��
(You must call the inspector when ready) Date Ready: 1 0� 1? j 9•-�
I, $] licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
01604 BERNE RD NE FRIDLEY 55421
Section No. Township Name or No. Range No. Fire No. County
Occupant
SHERRILL E'INL
Power Supplier Address
N!�P
Electrical Contractor (Company Name)
MA�T�R ELECTRIC�O�LD[G
Mailing Address (Contractor or Owner Performing Insta lation)
AutYloriee�d.Siqoature ( ontractor or wner Per orming Installatior
ANOKA
Phone No.
�'."7 1 _
Contractor License No.
8/95 STATE BOARD COPY - SEE INSTRUCYibfd'SOIQ BA�KbX' YELLOW COPY
Master Lic. No. (Plant Elect. Only)
Phone No.