P - 84095� �I���IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII Mg QUEaerstyOAve.LRm. SR1C8, �NP PEMNION04
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* 0 3 7 1 6 0 9 9* Phone (612) 642-0800
Home Duplex Apt. Bldg. Other: New
Commercial Industrial Farm Remo
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 IHSTALLATION
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Addn
Repair
Calculate Inspection Fee - This Inspection Request will not be accepted withoui 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 ONLV 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 . J0
Final ��_ _ . � _ ��
Investigative Fee
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.
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J�B NUMBER �t9706000
PLEASE PRINT OR TYPE
Reque�st,Qat�l,, / 9,7 Rough-in inspection required? ❑ Yes RAIo Inspection Other Than Rough-In: f'I. Ready Now ❑ Will Call
110 / �� �t
(You must call the inspector when ready) Date Ready: �������.�
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
Q►6270 VAN BUREN ST NE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
Occupant
JOHN F'
Power Supplier
Electrical Contractor (Company Name)
Mailing Address (GOntractor or
ANOKA
Phone No.
ANDERSOM 571-4838
Address
P
Contractor License No. Master Lic. No. (Plant Elect. Only)
�ture (Contractor or wner Per orming Installationr : Phone
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8/95 STATE BOARD COPV - SEE INSTRUCTIONS ON BACK OF YELLOW COPY