P - 83683III �� ���II� III�I IIIII IIIII IICII IIIII IIIII IIIII III) III) M8 n� Uota SsaO B e LR � SRe 8 6tNP PEnCN ION04
Y
� * 0 3 6 3 8 9 3 9* Phone(612)642-0800
Home Duplex Apt. Bidg. Other: New
Commercial Industrial Farm Remc
Air Cond. Htg. Equip. Water Htr. X 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 ot the white cqoy only.
SAVER'S SWITCH INSTALLATION
����
��:��
Addn
Calculate Inspection Fee - This Inspection 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 0
Sign/Outline Ltg. Xfmr. 15. d�
Alarm/Remote Control
Swimming Pool I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom � Ro�9n-ir, Date
X Speciallnspection i .01a �
Final Dat
Investigative � "�' — ��
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.
363-893 �
o ���� a �
/��� JOB NUMHER #�9706000
PLEASE PRINT OR TYPE
Rough-in inspection required? ❑ Yes �lo Inspection Other Than Rough-In: � Ready Now ❑ Will Call
(You must call the inspector when ready) Date Ready: %� �, %� 9%
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route NoJ City Zip Code
00235 LOGAN PKY HE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
ANOKA
Occupant Phone No.
MARC ALLEN NELSEN 574—?429
Power Supplier Address
Electrical Contractor (Company Name)
Contractor License No. I Master Lic. No. (Plant Elect. Only)
Mailing Address (Contractor or Owner Performing Installation) �.
Autho � Sign ur (Contr ctor or Owner Performi � t I Phone No.
EB-OOOOtA-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY