P - 82814Illlll IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIII IIII
*03797909*
REQUEST FOR ELECTRICAL INSPECTION �,���
Minnesota State Board of Electricity °'.
1821 University Ave., Rm. S-128, St. Paui, 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 �oace and on the 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 ONLV TOTAL ��
Sign/Outline Ltg. Xfmr. 1�'j.
Alarm/Remote Control
SWI�1'lfillll � I hereby certify that I inspected the electrical installation described F�rein on the dates stated
Irrigation Boom Rough-In Date
pecial lnspection
inal e
Investigative Fee ^
THIS INSTALLATION MAY BE ORDERED DI NNECTED IF NOT COMPLE N 18 MONTFIS.
OFFICE USE_ONLY This ��void nt from va� ate printed in this box.
379-7so� �� �NTER : �S�
.5�46
JOB NUMHER #�970600
PLEASE PRINT OR TYPE
Request Datg � 19 � 98 Rough-in inspection required? ❑ Yes ❑ Nov Inspection Other Than Rough-In: ❑ R4ady Now ❑ Will Call
n 1t
(You must call the inspector when ready) Date Ready:
I, ❑ j�ensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
00016 66 1/2 WAY NE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
AAIOKA
Occupant Phone No.
KENT D ADOLPHSO 5? -87
Power Supplier Address
NSP MPLS OFF'ICE
Electrical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Only)
E T C CO. I C. 1
Mailing Address (Contractor or Owner Performing Installation) �
Authorized i ure (Contractor or Owner Performing Installation) � A A� Phone No.
f' v � :
EB-00001A-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY