P - 83662'� �I�III��IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII
*03639390*
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. X Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above ihe work covered by this request. Enter remarks in this space and on the back of the white copy only.
SAVER'S SWITCH INSTALLATION
Calculate Inspecfion Fee - This Inspection Request will not be accepted withouf the conect fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps �I
Street Ltg./Traffic Sig. Above 200 Amps Above 100 Amps I
Transformer/Generator INSPECTOR'S USE ONLY TOTAL �
I Sign/Outline Ltg. Xfmr. 1S. 00
Alarm/Remote Control
ISwimming Pool I hereby certify that I inspected the electrical installation described herein on the dates stated
IIrrigation Boom Rough-In Date
I }t Speciallnspe i . 00 ,
Final -' Dat ��
Investigative .,...- ` y�.,.�-- _ �;.2�� � I
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.
363-939�
. /5 �sa 2� ��
J�B NUMBER �t9706000
PLEASE PRINT OR TYPE
Request�a� 17 � 97 Rough-in inspection required? ❑ Yes �Jo Inspection Other Than Rough-In: [x Ready Now ❑ Will Call
(You must call the inspector when ready) Date Ready: 7� 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
07447 CONCERTO CURV FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
AHOKA
Occupant Phone No.
KEVIN W SCHWARTZ 783-7866
Power Supplier Address
NSP PLS OFF
Electrical Conhactor (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Only)
Mailing Address (Contractor or Owner Performing Insta lation) '��
Author' Signature ontrac r Owner Performing,�s�ati n) Phone No. I
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� EB-00001A-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY I