P - 84090I Il�l�i��lll IIIII IIIII IIIII IIIII �IIII IIIII IIII IIII ME n�esota S atOe B aLd of EReCAL yNSPECTION
. � 1821 University Ave., Rm. S-128, St. Paul, MN 55104
� * 0 3 7 1 6 4 7 9* 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 emp. 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 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
}{ Special Inspection 1 . 50 — �
Final � f]aje` O
Investigative Fee o�
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.
371-647 [� � �
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JOB NUMHER #97060�0
PLEASE PRINT OR TYPE
Requa�fAaye17 � 9,� Rough-in inspection required? ❑ Yes [�Jo Inspection Other Than Rough-In: [� Ready Now ❑ Will Call
1 VJ
(You must call the inspector when ready) Date Ready: 10 � 1•7 � 9•7
I, $] licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
07399 SYMPHONY ST NE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
Occupant
Power Supplier
Electrical Contractor (Company Name)
AxoxA
Phone No.
ELM 786-4230
Address
Contractor License No. Master Lic. No. (Plant Elect. Only)
hon)
s a ' Phone No.
�8/95 STATE BOARD COPY - SEE IF15iFStiC7�OI��ACK OF YELLOW