P - 83406�. �IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII R82�1 UEiSersFORve.LRm. SR1C8, StN aPEMN 5O5N04 � ���,
Minnesota State Board of Electricity �
* * Phone (612) 642-0800 �"�-''%"
03789039
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 ihis request. Enter remarks in this space and on the back of the white cqoy only.
SAVER'S SWITCH INSTALLATIOH
Calculate Inspection Fee - This Inspection Request will not be accepied without the correct fee:
Other Fee � Service Entra�ce 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 tha[ I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In Date
X Special Inspection 1.�J' 0
Final D . _ t�
Investiga — d
THIS INSTAILA AY BE ORD�ED DISCONNECTED IF NOT COMPLET � WITHIN 18 MONTHS.
k�'`rICE USE ONLY This request wid 18 months from validation date pnnted in this box.
78-903� ' • iS �
�//3 �
JOB NUMBER �9706000
PLEASE PRINT OR TYPE
Request��16 � G�$ Rough-in inspection required? ❑ Yes �lo Inspection Other Than Rough-In:
(You must call the inspector when ready) Date Ready:
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City
07448 CONCERTO CURV FRIDLEY
Section No. Township Name or No. Range No. Fire No. County
Occupant
RUSSELL R
Power Supplier
NSP
Electrical Contractor (Company Name)
MOLBNCAMP
Address
liPLS OF'FICE
Contractor �icense No.
Mailing Address (Contractor or Owner Performing Installation)
or Owner Performing Installation)
Ready Now � wll Call
Zip Code
55432
AHOKA
Phone No.
786-6083
EB-00001A-11 8/95 STATE BOARD COPY - SEE INSTRUCI���K OF YELLOW COPY
Master Lic. No. (Plant Elect. Only)
Phone No.