P - 84038III'�I��IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII R8 Q UESe SFORve.LRm. SRiC8, StNPaPEMNI5O5No4 �����
Minnesota State Board of Electricity �
* 0 3 7 1 6 1 6 4* Phone (612) 642-0800 ����
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
II Air Cond. Htg. Equip. Water Htr. X 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 INSTALLATIOH
Calculate Inspection Fee - This Inspection Requesf will not be accepted without fhe conect tee:
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 iNSaecTOR�s use oN�v 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 Rough-In Date
}( Speciallnspection 1 . 50
� Final � e �� �
Investigative Fee -
THIS INSTALLATION MAY BE ORDERED DIS ONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
�--- __---------------------------------------------------------------
OFFICE USE ONLY This request void 18 months from validation date printed in this box.
371-616 [� � � �
1� -� 10�95 �
JOB NUMBER #9706000
PLEASE PRINT OR TYPE
Requa61.9ate1. J/ 97 Rough-in inspection required? ❑ Yes ❑xJo Inspection Other Than Rough-In: [� Ready Now ❑ Will Call
1YJ/
(You must call the inspector when ready) Date Ready:
I, g] licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
06264 BAKER AVE NE FRIDLEY 55432
' Section No. Township Name or No. Range No. Fire No. County
ANOKA
Occupant Phone No.
DOUGLAS W BLASE 571-6567
Power Supplier Address
Contractor License No. Master Lic. No. Plant Elect. Onl )
Electrical Contractor (Company Name) ( Y
Mailing Address (Contractor or Owner Performing Insta lation)
Au ' nature on rac r or wn Pe oimi g s a i � Phone No.
25� w
, - -
� EB-000 1 S/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY