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P - 83564IIIIGI�IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII R$ Q UESe SFORve.LRm. SR1C8 S�NS PEMNION04 ���� Minnesota State Board of Electricity � f* 0 3 9 2 3 4 1 4* Phone (612) 642-0800 ���� Home Duplex Apt. Bldg. Other: New Addn Commercial Industrial Farm Remod Repair Air Cond. Htg. Equip. Water Htr. Load 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 Calculate Inspection Fee - This Inspection Request will not be accepted without the conect 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�. 5Q) Alarm/Remote Control SWlfilfillflg POOI I hereby certify that I inspected the electrical installation described herein on the dates stated Irrigation Boom Rough-In Date X Speciallnspection 1. 50 Fna� c�+ Investigative F '� �/ THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS. —,r,,—.,.—� —�� OFFICE USE ONLY This request void 18 months from validation date printed in this box. 392-34�4] - �� ��-� � JOB HUMBER �9�06000 PLEASE PRINT OR TYPE Requegt �at� 30 � 98 Rough-in inspection required? ❑ Yes ❑xJo Inspection Other Than Rough-In: [x Ready Now ❑ wll Call (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.) City ZiP �d� 01358 66TH AVE Nfi FRIDLEY 55432 Section No. Township Name or No. Range No. Fire No. County ANOKA Occupant Phone No. BETH DAHLMEIER 572-2371 Power Supplier Address NSP MPL.S OFFICE Electrical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Only) Mailing Address (Contractor or Owner Performirg Installation) Authorized Signature (Contractor or Owner Performing Installation) ^� �� . Phone No. f�i/ / EB-00001A-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY