P - 83448REQUEST FOR ELECTRICAL INSPECTION
� Q Minnesota State Board of Electricity
6� 9-� F,� � 1821 University Ave., Rm. S-128, St. PauI,.MN 55104
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 the work covered by this request. Enter remarks in this space and on the back of the white copy
Add 100amp panel & outlets to garage
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # Service Entranc ize Fee # Circuits/F E
Mobile Home Park Stall ]. 0 to 00 Amps 2 5. 4 0 to 100 Am s i
Sheet Ltg./Traffic Sig. Above 200 Am s Above 100
Transformer/Generator INSPECTOR'S USE ONLY TC
�e Ltg. Xfmr.
iote Conhol
Pool
I herebvi certifv that I insoecfed fhe electrical
herein on �e
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Addn
Fee
� Investigative Fee � ����� ��� �
THIS INSTALLATION MAY BE ORDERED DISCANNECTED IF NOT COMPLETED WITHIN MNTHS.
._ OFFlCE USE ONLY This requesf void I S months from validation date prinfed in fhis box.
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9$ O% O O PLEASE PRINT OR TYPE
Requesf Dafe Rou h-in ins ection re uired? ❑ Yes
g p q ❑ No Inspection Other Than Rough-In: ❑ Ready Now ❑ Will Call
1'� � 1� 9$ �You must call the inspecror when ready) Date Ready:
I, � licensed contractor ❑ owner hereby request inspection oF the above electrical work at:
Job Addreu (Street, Box, or Route No.) Ciy Zip Code
620 58th Ave NE Fridley 55432
$ection No. Township Name or No. Ranpe No. Fire No. CounH
Anoka
Occupant Phone No.
Roger Swanson 571 7547
Power Supplier Address
Eleckical Conhacbr (Compony Name) Conhacror License No. Master Lic. No. (Plant Elect.
American Eagle Electric, In , CA00161
Mailing Address (Conhador or Owner Performing Installation) ��
18475 Rum River Blvd NW, ANoka, 55303.
Authorized Si n e Conhactor or Owner Perfor sfallafion Phone No.
/'��i� � � , f���/�,,,, � 753-0438
STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY