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* 0 3 9 2 3 5 4 7* Pnone(siz)saz-osao �-�•-
Home Duplex Apt Bldg. Other: New Addn
Commercial Industrial Farm Remod Renair
Agmt Other
Service
is space arxi on the back o1 the white copy only.
SAVER'S SWITCH INSTALLATION
/nq>ecfion Fee - This fnspection Request will no! be acceptetl without the cwiect fee:
Other Fee +� Service Entrance Size Fee � Circu@s/Feedere Fee
le Home Park Statl 0 to 200 Amps 0 to 100 Amps
INSPECTOq'S USE ONLV I TOTAL
ni y rv�i - I hereby cerlify Ihat 1 ioepec!etl ihe electriaal lnsffiIla[ion tlescnbotl herein on the dates sta�etl
Irrigation Boom Rough-In Date
j( Special Inspection 1 . .s0
Final D
InvestigativeFee -� �LO—�ry'
THIS INSTALLATION MAY BE ORDERED DISC NECTED IF NOT COMPLETED WITHIN 18 MONTHS,
OFFICE USE ONLY This reQUes� voitl 18 monMS from validation da�e pnntetl in t�is Mx.
392-354�] • �� S �
J6B NUMSER #99�060�dCn
PLEASE PRINT OR TYPE
ReV�ec[ �a� 3� � 9� Fouah-In inepec�ion repulretl? 0 Yes D�o Inspaction O[her Than Roogmin: [x Rezdy Now 0 Will Gall
1
Ivou musl call the Inspec[or when reetly) pate Ready � ��-�0 � e� �
I, � licensed contracta ❑ owner hereby request inspection of the above eleclrical work at:
Job Atltlress (SheeL Box, or Route Na_) City ZIF �utle
05518 MEISTEk RD FRIDLEY 55432
Sectlon No. Township Nama or No- Rengc No. Frc No- Counry
ntaoxn
ocouoanr anone nb_
LINDA L FORSCHEN 571-SS4'3
Power Suppller Pildress
FtSP MPLS UFFIGE
Elecineal Conhactor �Comparry Name� �ontracior Gcensz No- Masler Lic. No. (Plart Elaot Only�
MASTER ELEC'1 ttIC tiu. , INC, r,A0119'�
Maillrg Address (ConVactor or Owner Performing Inslallation)
� nuroonzetl SignaWre �(:o� r Owrier Performing I I
��0�
�,
EB-00001A-11 e,'95✓ STATE 80ARD COPY - SEE INSTFUCTIONS ON BACK OF VELLOW COPY