P - 83079.I IIFl��11111 Illll IIIII Illll IIIII IIIII Illll IIII IIII
*03869419*
REQUEST FOR ELECTRICAL INSPECTION ���
Minnesota State Board of Electricity � �'
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800 �`�'�'��
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Cond. Htg. Equip. Water Htr. oad Mgmt. Other:
Dryer Range Elec. Heat emp. Service
"X" above the work covered by this request Enter remarks in this space and on the back of the white copy only.
SAVER'S SWITCH INSTALLATIOAI
Calculaie Inspection Fee - This Inspection Request will not be acc�ted withoui 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. 15.�0
Alarm/Remote Control
Swimming Pool � r� :� I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom L� Rough-In oate
peciallnspection 15.0
inal D
Investigative Fee �� .6 �
THIS INSTALLATION MAY BE ORpERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request wid 18 months from validation date printed in this box.
386-941� • �,5; �
����
JOB HUMBER #970600
PLEASE PRINT OR TYPE
Request Da� f Z 4� 98 Rough-in inspection required? ❑ Yes ❑ Nox Inspection Other Than Rough-In: ❑ Ready Now ❑ Will Call
ll
(You must call the inspector when ready) Date Ready:
I, ❑ jQcensed contractor ❑ owner hereby request inspection of the above electrical work at:
.bb Address (Street, Box, or Route No.) City Zip Code
06281 STH ST NE FFfIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
AHOKA
Occupant Phone No.
Power Supplier Address
Electrical Contractor (Company Name) Cqntractor License No. Master Lic. No. (Plant Elect. Only)
Mailing ress ( n ractor or wner e orming Ins a lati n)
Authorize i at e( on rac or or Owner rforming Ins a a ion Phone No.
2�� ,�
EB-00001A-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY