P - 81394�IW�11III11IIIfIIIIIIIIIIlIII1 IIIIIIIIIIIi III REQUEST FOR E�CTRICAL INSPECTION ��� �
Minnesota State Board of Elec[ricity T
1821 University Ave., Rm. S-128, St. Paul, MN 55104 ���
* 0 3 9 2 0 8 8 1* Pno�e �siz� saz-osoo '�'°'"''
Home Duplex Apt Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Cond- Htg. Equip. Water Htr. �; Load Mgmt. Other:
Dryer Range Elec. Heat emp. Service
"X" above Ihe work covered by this requesL Enfcv �emarks in thrs space and wr [he back ot the whife copy only.
SAVER'�� SWITGH IS;STALLATiUN
ulate In�oecfion Fee - This lnspection Request wi71 not be acceptetl withou[ the ca�ect iee:
Other Fee � Service Enirance Size Fee ++ CircuilsfFeetlere Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Abeve 200_Amps Above 100_Amps
Transformer/Generator INSPECTOH'S USE ONLV TOTA��
Alarm/Remote
mat I Insvecied ihe eleGlncal ins�alla�IOn tlasaribetl herein on tlte tletes staled
Dete
' Investigative Fee / " �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
_ _ __ __ ____
OFFICE OSE ONLV This reQUest voitl 18 months fmm validaM1On tlate pnMed in �his box.
392-08�1 �/a6 � �
TOB NUMREk k4L;�G�4',ts
PLEASE PRINT OR TYPE
Reqws[�ate�4 / yg RwgM1-in inspection reQUiretl? � Ves fiNO Irespection Other Than Rough-In'. R Reatly Now 0 WIII Call
� �S Ti
(VOU must call �he Inspecbr when reatly) Date Ready:
c
I, �] licensed contractor ❑ owner hereby request inspection of the above electrical work at.
Joo Adtlress (Sheet Box, or Noute No.) Glry Zip Cotle
�6:'77 7TH ST NE FRZBLEY �5i3^<
Sec�ion No. Township Name o� No. qTn9e Nn Flre No. Counly
ANCiKA
Occupan[ Phone No.
Pdtlress
� Mailing Atltlress jCor�bactor or
Conbactor Llcensz No. � Mas�er Lic.
I qWnor¢sd bignaW�re (GOnU^ac��o/ or Uwne� Pertorming Insfalla�ion) �� -� -- I Plprie No
G' � ... ^
i! 1 �
—t�� 94� §��r
EB-00001A-11 8,�95 STATE 60ARD COPY - SEE INSTROCTIONS ON BACK OF YELLOW COPY