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*Q3869971*
REQUEST FOR ELECTRICAL INSPECTION �,��
Minnesota State Board of Electricity � �'
i821 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 INSTALLATION
Ca/culate Inspection Fee - This Ins,oeCtion Request will not be accepied 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. 15. 0
Alarm/Remote Control
Swimming Poo ' f^ 1 here6y certify that I inspected the electrical i�stallation described herein on the dates stated
Irrigation Boom Rou9h-In Date
pecial Inspection �
InvestigativeFee -- .
THIS INSTALLATION MAY BE ORDERED DISC ECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request wid 18 months from validation date printed in this box.
386-997 1 • ,5 , �
S7 �/'
PLEASE PRINT OR TYPE .JOB HUHHER #�970600
Request Da[e� I 14I98 Rough-in inspection required? ❑ Yes ❑ Nq� Inspection Other Than Rough-In: ❑ geady Now ❑ Will Call
(You must call the inspecta when ready) li Date Ready: 1�
I, ❑�censed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) Ciry Zip Code
07550 5TH ST NE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
ANOKA
Occupant Phone No.
Power �pplier Address
Electrica �tractor (Comparry Name) trac[or License o. Master Lic. No. (Plant Elect. Ony)
Mailing ress ( ractor ner ormuig ns a I�atidn� '
Authon tute( n O r or I ' Phone No.
/'�
EB-OOOOtA-t i 8/95 STATE BOARD COPY - SEE INSTRUCTION O B CK OF YELLOW COPY