P - 84098�I I��III IIIII (IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII M8 n� Uota SsatOe B aLRm SR1C8, St PaPEMNION04
* 0 3 7 1 6 7 9 2* Phone (612) 642-0800
Home Duplex Apt. Bldg. Other: New
Commercial Industrial Farm Remod
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
X" aBove ihe work covered by this request. Enter remarks in this space and on the back ot the white copy only.
SAVER'S SWITCH INSTALLATION
����
�.;���
Addn
Repair
Calculate In$oection Fee - This Inspection Request will nof be accepted without the conect 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. rJ0
Alarm/Remote qntr I
Swimming Po u !! I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In Date
X Speciallnspection 1 . 50
Final D te �
Investigative Fee
THIS INSTALLATION MAY BE ORDERED DIS ONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validation date printed in this box.
371-679 [,� l��
��G ��
JOB NUMBER #9706000
PLEASE PRINT OR TYPE
Requ�t�a1e1•� � g7 Rough-in inspection required? ❑ Yes [�No Inspection Other Than Rough-In: j� Ready Now ❑ Will Call
., (You must calltheinspector 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
01439 WINDEMERE DR NE FRIDLEY 55421
Section No. Township Name or No. Range No. Fire No. County
ANOKA
Occupant Phone No.
CARL B PETERSEN 571-4836
Power Supplier Address
Electrical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Only)
MASTER ELECTRIC CD. INC. CA011'32
Mailing Address (Contractor or Owner Performing Installation)
(Contractor or Owner Performing Installation)
EB-00001 -11 /95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY
Phone No.