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REQUEST FOR ELECTRICAL WSPECTION �,��
Minnesota State Board of Electricity � °i
1821 University Ave., Rm. S-128, St. Paul, MN 55104 �
Phone (612) 642-0800 ��'-'°��"
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Cond. Htg. Equip. Water Htr. X 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 onty.
SAVER'S SWITCH INSTALLATIOH
Calculate Insoection 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 ONLY TOTAL
Sign/Outline Ltg. Xfmr. . 50
Alarm/Remote Control
Swimtlling POOI I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In oace
j{ Special Inspectio , S0
Final
Investigative Fe � � �� =--.�—= c� '�
THIS INSTALLATION MAY B ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
--�--------�-�-•- --,--,----�--____�_�Y__�_�_..,_._.__._..�.,t.�
OFFICE USE ONLY This iequsst wid 18 months from vatidation date printed in this box.
392-33�5] �� �� � ��
JOB NUMBER #9�06000
PLEASE PRINT OR TYPE
Requebt Dats30 /�g Rough-in inspection required? ❑ Yes ❑Xlo Inspection Other Than Rough-In: [� Ready Now ❑ Will Call
�1J
(You must call the inspector when ready) Date Ready:
I, � ticensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City ZiP Code
00552 66TH AVE NE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
ANOKA
Occupant Phone No.
WIL.L.IAM J JR BONNER 57Z-1271
Power Supplier Address
Electrical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Onty)
Mailing Address (Contractor or Owner Performing Insta ation)
Aut onz ignature ( n rac or or wner Pe orming ns al i - r . Phone No.
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EB-00001A-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY