P - 82815IIIIII NII) IIIII IIIII IIIII IIIII I�III IIIII IIII IIII
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REQUEST FOR ELECTRICAL INSPECTION �,��
Minnesota State Board of Electricity � °'
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800 '�"�"'�
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Cond. Htg. Equip. Water Htr. oad Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in ihis space and on the back of the white cqoy only.
SAVER'S SWITCH INSTALLATION
Calculate In�oection Fee - This Inspection Requesi will not be accepted without the conect fee:
Other Fee # Service Entrance Size Fee u 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 �j
Sign/Outline Ltg. Xfmr. 15.
Alarm/Remote Control
Swimming Po I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In Date
peciallnspection 15.0 ,�ai o�
Investigative Fee a r� ?
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.
379-791� � � 5�
� 7
JOB HUMBER �970600
PLEASE PRINT OR TYPE
Request Da� � 1�9 � 98 Rough-in inspection required? ❑ Yes ❑ NoK Inspection Other Than Rough-In: ❑ Ready Now � Will Call
A
(You must call the inspector when ready) Date Ready:
I, ❑�censed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Raute No.) City Zip Cade
05031 CLEARVIEW ST NE FRIDLEY 55421
Section No. Township Name or No. Range No. Fire No. County
ANOKA
Occupant Phone No.
DOUGLAS C ANDERSON 572-8719
Power Supplier Address
NSP MPI.S OFF'ICE
Electrical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Only)
Mailing Address (Contractor or Owner Performing Installation)
Authorized Sign ure Contractor or Owner Performing In�llatj,pn) � Phone No.
�/v3� 5
EB-00001A-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY