P - 82842I�IIIII INII NIII IIIII IIIII IIIII IIIII IIII IIII
*03799061*
REQUEST FOR ELECTRICAL WSPECTION �....
Minnesota State Board of Electricity � �`�a
1821 University Ave., Rm. S-128, St. Paul, MN 55104 �
Phone (612) 642-0800 �'�`'�°'%"�
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm � Q S C Remod Repair
Air Cond. Htg. Equip. Water Htr. oad Mgmt. Other:
Dryer Range Elec. Heat emp. Service
"K" above the work coveied by this requesL Enter remarks rn thrs space and on the back of the whrte cqoy onty.
SAVER'S SWITCH IHSTALLATION
Calculate Inspection Fee - This Inspeciion Request will not 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 ,s"O
Sign/Outline Ltg. Xfmr. 15. $�'
Alarm/Remote Control
Swimming Pool I hereb cert� that I ins
y fy pected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In Date
pecial Inspect'
mal D�_ ! q
Investigative Fe ( C
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validation date printed in this box.
379-906�] ,�
�5 �� D� �► 9
1�.� JOH NUMBER �970600
PLEASE PRINT OR TYPE
Request Da� � 19 � 9$ Rough-in inspecYbn required? ❑ Yes ❑ NOx Inspection Other Than Rough-In: ❑ 1�ady Now ❑ Will Call
(You must call the inspector when ready) Date Ready:
I, ❑xjcensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No,) City Zip Code
00185 49TH AVE NE FRIDLEY 55421
Section No. Township Name or No. Range No. Fire No. County
ANOKA
Occupant phone No.
LE 3 SL 5'7 - 40
Power Supplier Address _
NSP MPLS OFFICE
Electrical Contractor (Comparry Name) Contractor License No. Master Lic. No. (Plant Elect. Onty)
ER ELECTRIC . INC. 011
Mailing Address (CoMractor or Owner Performing Installation)
Authorized Signa r ntractor or Owner Performing Installation) 2 6 3 8 2 Phone No.
EB-00001A-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY