P - 84109��III IIIII IIIII IIIII IIIII IIII) (IIII IIIII IIII IIII
*n��y651�*
REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone(612)642-0800
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Home Duplex Apt. Bldg. Other: New Addn I
Commercial Industrial Farm Remod Repair
Air Cond. Htg. Equip. Water Htr. X 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 only. I
SAVER'S SWITCH INSTALLATION 'I
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. 15. 50
Alarm/Remote o,ia#r
Swimming Po V � y n I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In Date
}{ Speciallnspection 1 . 50 c�
Final � � yy.� C� X
Investigative Fee � / ��
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validation date printed in this box.
371-651 [� � 5� s� I
R�° ` `" � JOB NUMBER #9706000 I
PLEASE PRINT OR TYPE
Reque�st,Qat�17 /�,.! Rough-in inspection required? ❑ Yes �o Inspection Other Than Rough-In: f.l. Ready Now ❑ Will Call
1 t0 / 7i
(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.) Ciry Zip Code
01505 6@TH AVE NE F}2IDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
Occupant Phone No.
Power Supplier Address
Electrical Contractor (Company Name) Contractor License No. Master Lia No. (Plant Elect. Only)
Maihng ress ontrac r or wner er orming n�falila i '
Au i tu r o P hn a • Phone No.
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I EB-00001 -11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLO O Y
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