P - 83653I �' III�III�IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII R8 QUESe SFORve.LRm. SR�C8 StNS PEMNION04 ���^��
Minnesota State Board of Electncity '�
* 0 3 6 3 9 0 7 7* Phone (612) 642-0800 ��`"�-'""'
�'- i-iome Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
above the work covered by this request. Enter remarks in this space and on the back ot the white cqoy only.
SAVER'S SWITCH INSTALLATION
Calculate Inspection Fee - This Inspection Request will not be accepied without 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 � SO
Sign/Outline Ltg. Xfmr. 15.��
Alarm/Remote Control
Swimming Pool I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In Date
}( Speciallnsp � • 0 Final '' Da �
Investigative e , `3'�-� ^�
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.
363-907 � �� �
�5�� � JOH NUMBER �9706000
PLEASE PRINT OR TYPE
Rough-in inspection required? ❑ Yes ❑}�Jo Inspection Other Than Rough-In: �[ Ready Now ❑ Will Call
(You must call the inspector when ready) Date Ready: %� 1%� 9%
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
06645 ARTHUR ST NE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
AHOKA
Occupant
JAKES w
Power Supplier
Electrical Contractor (Company Name)
Mailing Address (Contractor or Owner Performing
Phone No.
PEARBON
Address
I�iPLS OFFICE
Contractor License No.
or Owner Performing Installation)
571-7349
EB-00001A-11 8/95 STATE BOARD COTY ='�E�INSTRUCTIONS ON BACK OF YELLOW COPY
Master Lic. No. (Plant Elect. Only)
No.