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