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*03716248*
Home Duqlex AK
REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone(612)642-0800
Other: New
Commercial Industrial Farm Remod
Air Cond. Htg. Equip. Water Htr. j{ 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 copy only.
SAVSR'S SWITCH INSTALLATI�H
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Addn
Repair
:alculate In�uection Fee - This Inspection Request will not be accepted wiihout the 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 ONLY TOTAL
Sign/Outline Ltg. Xfmr. 15. 50
Alarm/Remote Control
Swimming Poot'' �� Y� 1 I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom � Rough-In oate
K Speciallnspection i. 50 Final ���Z3. �t'
Investigative Fee
THIS INSTALLATION MAY BE ORDERED DISCO CTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validation date printed in this box.
371-624 � � ��S(�
� ��Q � � JOB NUMBER #9706000
PLEASE PRINT OR TYPE
Requ�stAa�17' 9,! Rough-in inspection required? ❑ Yes f1Alo Inspection Other Than Rough-In: �.I, Ready Now ❑ Will Call
lYJ lt �t
(You must call the inspector when ready) Date Ready: 10 � 1•7 ��•7
I, $] licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route NoJ City Zip Code
Q15411 7TH ST NE FFtIDLEY 55421
Section No. Township Name or No. Range No. Fire No. County
Occupant
Power Supplier
Address
ANOKA
Phone No.
Electrical Contractor (Company Name) Contractor License No.
Mad�ng dress ontractor or Owner er orming nst lahon
Au ' natu o r or wn Pe oim g s a �
M�
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EB-00001 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YI
Master Lic. No. (Plant Elect. Only)
Phone No.