P - 83472I�IIII �II IIIII IIII) IIIII IIIII IIIII (IIII (III IIII
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REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity ���� `�
1821 University Ave., Rm. S-128, St. Paul, MN 55104 �.
Phone (612) 642-0800 �' ' E
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Cond. Htg. Equip. Water Htr. X Load Mgmt. Other:
Dryer Range Elec. Heat emp. Service
"X" above the work covered by this request Enter remarks in this space and on fhe back of the white cqoy only.
SAVER'S SWITCH INSTALLATION
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
Sign/Outline Ltg. Xfmr. ],rj. �'j0
Alarm/Remote Control
Swimming P �� I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In Date
j{ Special Inspection 1. S0
Final � , D t �
Investigative Fee � — r/
_ THIS INSTALLATION MAY B� ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validation date printed in this box.
378-915�] �S�
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JOB NUMBER #9706000
PLEASE PRINT OR TYPE
Requesr��16 � 9$ Rough-in inspection required? ❑ Yes [kNo Inspection Other Than Rough-In: � Ready Now ❑ Will Call
(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
0�410 57TH PL HE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
ANOKA
Occupant Phone No.
WARREN O SUNDERLAND 574-9518
Power Supplier Address
Electrical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Only)
Mailing Address (Contractor or Owner Performing Insta lation)
zed ignature ontrac or or wner Pe orming Ins a ation Phone No.
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EB-OOOOtA- S/95 STATE BOARD COPY - SEE INSTRUCTIONS N ACK OF YELLOW COPY