P - 84119IIIIII �III IIIII (III) (IIII (IIII IIIII IIIII IIII IIII
*03716503*
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. Bidg. Other: New
Commercial Industrial Farm Remod
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 this space and on the back of the white cqoy only.
SAVER'S SWITGH INSTALLATIOH
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Addn
Calculate Inspection Fee - This In�nection Request will not be accepted wiihoui ihe correct 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. 15. 5�
Alarm/Remote Control
Swimming Poo ��$ ��;^! I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In Date
X Speciallnspection 1 . 50
Final . �� ^ C�
Investigative Fee Z
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
� OFFICE USE ONLY This request void 18 months from validation date printed in this box.
371-650 � ���,�
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JOB HUMBER #9706000
PLEASE PRINT OR TYPE
Reque�i�a�e17 ��7 Rough-in inspection required? ❑ Yes �lo Inspection Other Than Rough-In: [� Ready Now ❑ Will Call
(You must call the inspector when ready) Date Ready: 10I 17 � 97
I, �] licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
01640 75TH AVE NE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
Occupant
ANGELA M Hl1BER
Power Supplier Address
NSP M
Electrical Contractor (Company Name)
MA�T -R - .E TRT O. , ING_
Mailing Address (Contractor or Owner Performing Installation)
Aut qd Signature (Contractor or wner Performing Installation)
ANOKA
Phone No.
785-6036
Contractor License No.
8/95 STATE BOARD COPY - SEE INSTRlTCT16N$bN BACK OF YELLOW COPY
Master Lic. No. (Plant ElecT. Only)
No.