P - 83475,
���III IIIII (III) IIIII IIII) IIIII (IIII IIIII (III IIII
*037889Q8*
REQUEST FOR ELECTRICAL INSPECTION ��
Minnesota State Board of Electricity ����. �-
1821 University Ave., Rm. S-128, St. Paul, MN 55104 � �
Phone (612) 642-0800 �'��
Home Duplex Apt. Bldg. Other: New Addn
Commerciai Industrial Farm Remod Repair
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in ihis �oace and on the back of the white copy only.
SAVER'S SWITCH INSTALLATION
Calculate ln�oection Fee - This lnspection Request will not be accepted without the correci 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. S0
Alarm/
SWlllll'Tllllg I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In Date
j{ Special Inspection 1 . �'j0
Final Dat� _ �� �/
Investigative Fee — �
THIS INSTALLATION MAY gE ORDERED DISC'_qNNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
: USE ONLY This request void 18 months from validation date printed in this box.
��/�� �
JOB NUMBER �9706000
❑ Yes [�Jo Inspection Other Than Rough-In: � Ready Now ❑ Will Call
ienready) Date Ready: �
spection of the above electrical work at:
City Zip Code �.
FRIDLEY 55432
Fire No. County
AHOKA �,
Phone No. I
'sH 574-9517
'LS OFFICE
Contractor License No. Master Lic. No. (Plant Elect. Only)
CA01192
MN. 55378
;^� Phone No.
J �..
�/
RUCTIONS ON BACK OF YELLOW COPY