P - 81401II I Ilill I II II I IIII I I III I I II REDUEST FOR ELECTRICAL INSPECTION a`*',i°�,
Minnesota State Board of Electricity � �_
1821 University Ave., Rm. S-128, St. Paul, MN 55104 �����
�* 0 3 9 2 3 9 9 2* Phone(612�642-0800 #
Home Duplex Apt. Bldg. Other: New Addn
�.quip. Water Htr. g Load Mgmt. O[her:
Elec. Heat emp. Service
6y fhis request Enter remarks in fhis goace ar�tl on the back o( the whife copy only.
SAVEk'S SWITCH INSTALLATION
In�ectiw Fee - This InspecGOn Request wil! not be acceptetl without the cw�ect tee:
OtBer Fee � Service Entrance Size Fee �+ CircoNSlFeetlers Fee
le Home Park Stall O io 200 Amps 0 to 100 Amps
;t Ltg./Traffic Sic�. Above 200_Amps Above 100_Amps
sformer/Generator INSPELTOR'S USE ONLY TOTAL
/Outline Lta. Xfmr. ��. 50
the electr�calinstallatlon tlesclibetl
Irrigation Boom— '" " Rough-in ua�e
Speciallnspection F�,nai � C.�' .
Investigative Fee � � —
THIS INSTALLATION MAY BE ORDERE� DISCONNECTED IF NOT COMPLEIED WITHIN 1 ONTHS.
OFFICE USE ONLY Thls requesl voltl 18 mon[hs irom vellda9on tlete Ptln[atl in this box.
392-39�] � /a�5 �
SOB NUMBER #�06m0(�
PLEASE PRINT OR TYPE
Requey1 �a� �� �9$ Rough-In inspection requiretl? � Yes �.No Inspeclion Other Than Rough-In: � Ready Now 0 Will Call
L tL
(VOU mun cau tr� ��,�oeaor �vnen ready� Dare aeady: � � � ��� ��
I, �✓f licensetl conhacfor ❑ ow�r hereby request inspection of the above elecirical work at:
Job Htldress �Street. Box, or Route Na.) Ci!y Zip Cotle
00392 66TH AVE NE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
Occupan�
ANOKA
Phane No
Elechical ConNac�or (Comp.�ny Name) ContraIXOr Lloenss No. Mastar Gc. No. (%an� Elect Only)
Me� ing PfJdress ( on[rec[or or wner e orming Insta tion)
Hut e g aW ( r or w Pe rfil i ' Phone No.
— c — J�
EB-0p001A-11 8i95 STATE BOAHO COPV - SEE INS U 1� S � CK Of YELLOW COPY