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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