P - 83061I Illlfl IIIiI IIIII IIII! IIIII 41111 lIII! Iilll IIII IIII
*03869765*
REQUEST FOR ELECTRICAL INSPECTION ��
Minnesota State Board of Electricity � �
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800 �"�'-`"�F
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 emp. Service
"X" above the work covered by this request. Enter remarks in this space and on the back of the white cqoy only.
SAVER'S SWITCH IHSTALLATIOH
Calculate lnspection Fee - This InsAection 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
TransformerlGenerator iwsPecroR'S USE ONLY TOTAL
Sign/Outline Ltg. Xfmr. 15. �Q1
Alarm/Remote Control
Swimming Pool I hereby certify that I inspected the electrical insta�lation described herein on the dates stated
Irrigation Boom Rough-In oa�e
pecial Inspection 1 S.� �� p
Investigative Fee - � 2/�-f
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 m from validation date printed in this box.
386-97�] � �s �
����
JOB NUMBER �k970600
PLEASE PRINT OR TYPE
Request Da� � 14 � 98 Rough-in inspection required? ❑ Yes ❑ Ndx Inspection Other Than Rough-In: ❑ I�ady Now ❑ Will Call
(You must call the inspector when ready) Date Ready:
I, ❑ ifcensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, 8ox, or Route No.) City Zip Code
06880 E RIVER RD FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. Cainty
ANOKA
Occupant Phone No.
ANNA A PRZBIlLA 571-6433
Power Supplier Address
NSP MPLS OF'FICE
Electrical CA�tractor (Comparry Name) Contractor License Plo. Master Lic. No. (Plant Elect. Onty)
Mailing Address (Contractor or Owner Performing Installation)
Authorize Si nature ( on ractor or Owner rforming Inst ion � Phone No.
6
EB-00001A-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY