P - 84067(Ii9I��IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII R8 � UESe SFORve.LRm. SR1C8, StNS PEMNION04 �:����
Minnesota State Board of Electriaty �
� * 0 3 7 1 6 1 8 0* Phone (612) 642-0800 �"�'�
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
SAVER'S SWITCH INSTALLATION
:alculate Inspection Fee - This Inspeciion 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. 15. 50
Alarm/Remote Control
Swimming Pool ����� ,' � I hereby certify that I inspected the electrical installation described herein on the dates stated
IfflgBt1011 BOOII'1 'L �� Rough-In Date
Speciallnspection •
Investigative Fee F�nal �� � � ����— �
THIS INSTALLATION MAY BE ORDERED DISC NNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
^ OFFICE USE ONLY This request void 18 months from validation date printed in this box.
371-618 � ����
����� .TCIB NUMBER �i9706000
PLEASE PRINT OR TYPE
Requesf.i➢a� 17 � 97 Rough-in inspection required? ❑ Yes ❑�lo Inspection Other Than Rough-In: [� Ready Now ❑ Will Call
1 iLJ
(You must call the inspector when ready) Date Ready: 10I 1% I S%
I, g] licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
063?0 JEFFERSON ST NE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
ANOKA
Occupant Phone No.
STEVEN J BRANCA 572-0382
Power Supplier Address
Electrical Contractor (Company Name) Contractor License No. I Master Lic. No. (Plant Elect. Only)
Mailing Address (Contractor or Owner Performing
or
8/95 STATE BOARD COPY - SEE INS`TRClCTIONS ON BACK OF YELLOW COPY
Phone No.