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Home Duplex Apt. Bldg. Other: New
Commercial Industrial Farm Remod
II Air Cond. Htg. Equip. Water Htr. X Load Mgmt. Other:
I 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
ulate 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
Transtormer/Generator INSPECTOR'S USE ONLY TOTAL � s�
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
Speciallnspectio 1 .00
Final Dat
Investigative Fe �—"�-S
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.
363-937� �
/�, �O � ���
JOB NUMBER #t9706000
PLEASE PRINT OR TYPE
Request'j7aSE 1'� � C3"J Rough-in inspection required? ❑ Yes �(Jo Inspection Other Than Rough-In: � Ready Now ❑ Will Call
(You must call the inspector when ready) Date Ready: "J � 1%� 9%
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route NoJ Ciry Zip Code
0?696 VAN BUREN ST NE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
ANOKA
Occupant Phone No.
DALE W SCHKIDT 784-5060
Power Supplier Address
Electrical Contractor (Company Name)
Mailing Address (Contractor or Owner Performing
Installation)
V
A-11 8/95 STATE BOARD COPY - SEE
Contractor License No.
BACK OF YELLOW COPY
Master Lic. No. (Plant Elect. Only)
No.