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IIIIIIt1111IIlIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII R$ QU�ESe SFORve.LRm. SR1C8, StNPaPEMNION04 ����
Minnesota State Board of Electriaty �
' * O � � � � 9 1 7 * Phone (612) 642-0800 �"°�'��
Home Duplex Apt. B4dg. Other: New Addn
Commercial 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 ihis requesi. Enter remarks in this space and on the back of the white copy only.
Install new power pole - rempunt electric service to it.
Metro Waste meter site. Our Job #11691.
Calculate Inspection Fee - This Inspection Repuest will not be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feetlefs Fee
Mobile Home Park Stall O to mps ; X O to 100 Amps 5; ��
Street Ltg./Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
Sign/Outline Ltg. Xfmr. 25.5�
Alarm/Remote Control
SWIfTII'Tllllg POO� � I hereby certify that I inspected the electrical installation described herein on the dates stated
II'1'ICJdt1011 BOO � Rough-In Date
Special lnspe
Final e �
Investigative Fee _ '�
THIS INSTALLATION MAY BE ORDERED DIS ECTED IF NOT COMPLETED WITHIN 18 MONTHS.
� �� OFFICE USE ONLY This request void 18 months from validation date printed i�.... ..
351-891
�'� � ��' '����'�
PLEASE PRINT OR TYPE
Request Date �Rough-in inspection required? ❑ Yes � No Inspection Other Than Rough-In: ❑ Ready Now � Will Call
-� /� /97 (You must call the inspector when ready) Date Ready:
1/ J
I, [�licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
,, ,S •-�@{ 69th Ave . N . E . -�
Section No. Township Name or No. � Range No. Fire Na � County �
Occupant
Power Supplier
Address
Phone No.
Electrical Contractor (Company Name) Contractor License No.
Mailing dress (Contractor or Owner Performing Installation)
Authorized � ture (Contractor or O ne� erforming In II 'on) �
, �3��
Eg_00001A-11 8/95 STATE BOARD C PY - SEE INSTRUCTIONS ON BACK OF YELLOW COPV
Master Lic. No. (Plant Elect. Only)
Phone No.
224-2585