P - 84056.!I�IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII 1n82�j lJo ae SayO B a Rm. SR1C8,cStN aPEMNION04
� * 0 3 7 1 6 3 7 0* Phone (612) 642-0800
Home Duplex Apt. Bldg. Other: New
Commercial Industrial Farm Remo
' Air Cond. Htg. Equip. Water Htr. X Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" a6ove the work covered by ihis request. Enter remarks in this space and on the back of the white copy only.
SAVER'S SWITCH IHSTALLATIOId
���
��.���
I Addn
Repair
�alculaie Inspection Fee - This Inspection Request will not be accepted withouf 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. 15. 50
Alarm/Remote Control
Swimming Poo � � 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—'— � Ci
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.
371-637 [� � �
� ���� 10B NUMHER #9706000
PLEASE PRINT OR TYPE
Reque�T�a� 17 ��+7 Rough-in inspection required? ❑ Yes ❑xJo Inspection Other Than Rough-In: [� Ready Now ❑ Will Call
(You must call the inspector when ready) Date Ready: ��� � 7��7
I, $] licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
01061 HATHAWAY LN NE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
Occupant
JOHN A
Power Supplier
Electrical Contractor (Company Name)
MASTFR .I. _(°TRTC' C.1
Mailing Address (Contractor or Owner Performing
or
GEIGER
Address
MP
Contractor License No.
�Ilation)
p.ysr.� Ku �„���n
3 Installation)
'13 �'r,., r�.
ANOKA
Phone No.
rJ% 1 —.r7%
8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON �ACKC7�NELLOW COPY
Master Lic. No. (Plant Elect. Only)
Phone No.