P - 83666�
� , II�II�IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII REQUESTFORELECTRICALINSPECTION ��a
Minnesota State Board of Electncity �
8 1 Un versity Ave., Rm. S 128, St. Paul, MN 55104
* 0 3 6 3 2 9 7 3* Phone (612) 642-0800 '�����
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 this request. Enter remarks in this space and on the back ot the white copy only.
SAVER'S SWITCH INSTALLATION
Calculate Inspection Fee - This Inspection Requesi will not be accepted wiihout ihe 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
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
Sign/Outline Ltg. Xfmr. 15.�e° I
Alarm/Remote Control i
Swimming Pool I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In Date
X Speciallnspec 0
Final > Date
Investigative F � �- � � � � �. �� -/�_ F
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.
363-297�] � o � ;
�5��� � � � oe HU�BER �9706000 �
I
PLEASE PRINT OR TYPE i
RequesN�ja� 1'� � 13"� Rough-in inspection required? ❑ Yes �Jo Inspection Other Than Rough-In: � Ready Now ❑ Will Call
(You must call the inspector when ready) Date Ready: '� � 1"J I Cj'� I
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
07255 E RIVER RD FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
Occupant
YVONNE
Power Supplier
NSP
Electrical Contractor (Company Name)
Mailing Address (Contractor or Owner Performing
ANOKA
Phone No.
GRAVES 571-5999
Address
NPLS OF'FICE
Contractor License No.
Master Lic. No. (Plant Elect. Only)
�d Sign ure (Co a r r�rfp�m�l�allation), Phone No.
a
-� � :;� 47�
A-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY