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* 0 3 6 3 3 y 7 g * Phone(612)642-0800
Home Duplex Apt. Bldg. 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 of the white copy only.
SAVER'S SWITCH INSTALLATiON
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Addn
Repair
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fiee:
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 w �
Sign/Outline Ltg. Xfmr. 15. 00
Alarm/Remote Control
Swimming Pool I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In Date
Speciallnspection •
Investigati F��ai __. ,. ._.. �..t_..i..,-- Da�-, Z ��
THIS INSTALLA O Y BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validation date printed in this box.
363-317� •
/��� ���8 � JOB NUMBER �l9706000
PLEASE PRINT OR TYPE
Request 2j� Rough-in inspection required? ❑ Yes o Inspection Other Than Rough-In: � Ready Now ❑ Will Call
(You must call the inspector when ready) Date Ready: 7� 1"'f � 9'f'
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
07493 MELODY DR NE RRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
Occupant
![ARY A
Power Supplier
NSP
Electrical Contractor (Company Name)
HOF�'liAN
Address
MPLS OF'FICE
Contractor License No.
Mailing Address (Contractor or Owner Performing Installation)
12467 BOONE AVE S. SAV�
Autho� Sign�tur�jContra r 9r Owner Performing Install.
ANOKA
Phone No.
780-5911
. �'uC/
A-11 8/95 STATE BOARD C - I IONS ON BACK OF YELLOW COPY
Master Lic. No. (Plant Elect. Only)
Phone No.