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*03804283*
REQUEST FOR ELECTRICAL INSPECTION �,��
Minnesota State Board of Electricity � °i°
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800 �`��°'- �
Nome Duplex Apt. Bldg. Other: [� New Addn
Commercial Industrial Farm +J Q S G Remod Repair
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat emp. Service
"X" above the work covered by this �equest. Enter remarks in this space and on the back of the white copy only.
SAVER'S SWITCH IAiSTALLATIOK
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 / Si s`(�
SignlOutline Ltg. Xfmr.
` Alarm/Remote Control
Swimming Po I hereby certify that I inspected the electrical installation described herein on the dates stated
irrigation Boo I Rough-In Date
Special Inspection
Final e r� s��
Investigative Fee � l
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
-,^---- --..._�______�_�___�___�____.,__.__ _
OFFICE USE ONLV This request void 18 months from valida[ion date printed in this box.
3so-42� �i �
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PLEASE PRINT OR TYPE JOH NUMBER �97@6000
Request Date Rough-in inspection 2quired? Q Yes ❑ No Inspection Other Than Rough-In: Ready Now ❑ Will Call
7��7 � 98 (You must call the inspector when ready) X 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
�0�15 57TH PL NE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
ANOKA
Occupant ^ � Phone No.
Power Supplier Address
Electrical Contractor (Cqmparry Name) CoMractor License No. Master Lic. No. (Plant Elect. Ony)
Mailing Address (Contractor or Owner Perfaming Instal tion)
� Auth nze at or e r i I t I to � Phone No.
G�.� � � -
EB-OOOOtA-11 8l95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY