P - 84037(IIIII�II�IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII R$ Q UESe SFORve.LRm. SR1C8, St PaPEMNION04 � ��.
Minnesota State Board of Electncity �
�� * 0 3 7 1 6 8 g 3* Phone (612) 642-0800 ���"�"
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 the work covered by this request. Enter remarks in this space and on the back of the white copy only.
SAVER'S SWITCH INSTALLATION
Calculate Inspection Fee - This Inspection Request will not be accepted 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
Sign/Outline Ltg. Xfmr. 15. 50
Alarm/Remote Control
Swimming Pool .� I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom � �j Rough-In Date
}{ Speciallnspection 1 . 50
Final � �^ Da _ z _ � �r
Investigative Fee 1` ri
�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.
371-688 � �5, �
� ���� JOH NUMBER #9706000
PLEASE PRINT OR TYPE
Reque�l�aJe17 �97 Rough-in inspection required? ❑ Yes [�Vo Inspection Other Than Rough-In: � Ready Now ❑ Will Call
(YOU must call the inspector when ready) Date Ready: 10 � 17 � 97
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) Ciry Zip Code
07600 BACON DR NE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
Ocwpant
KENNETH A
Power Supplier
Electrical Contractor (Company Name)
Mailing Address (Contractor or Owner Performing
AHOKA
Phone No.
SCRIBNER 784-8415
Address
Contractor License No. Master Lic. No. (Plant Elect. Only)
iature (Contractor or Owner Performing Installation) �j �� I Phone
r r� �;
�., ."
8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY