P - 83417.�I 11C�11111IIIII IIIII IIIII IIIII illll IIIII IIII IIII
REQUEST FOR ELECTRICAL INSPECTION �,c�TME�
Minnesota State Board of Electricity °'"
1821 University Ave., Rm. S-128, St. Paul, MN 55104 �
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* 0 3 7 8 8 8 7 4* Phone(612)642-0800 =—
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Cond. Htg. Equip. Water Htr. }t Load Mgmt. Other:
Dryer Range Elec. Heat Temp. 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 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
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
Sign/Outline Ltg. Xfmr. 15. 50
Alarm/Remote Control
SWIfYI O I hereby certify that I inspected the electrical installation described herein on the dates stated
f rrigati Rough-In Date
}C S ecial Inspection 1. S0
p Final . /� - � � . c, __ /��
Investigative Fee �_____--�'`— " ��" �
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.
378-887� • � S �
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JOB NUMBER #�9706000
PLEASE PRINT OR TYPE
Requesr��16 � 9$ Rough-in inspection required? ❑ Yes [�No Inspection Other Than Rough-In: � Ready Now ❑ Will Call
(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 Zip Code
00264 ELY ST HE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
ANOKA
Occupant Phone No.
EUGEME O ERICKSON 786-5877
Power Supplier Address
NSP MPLS OFFICE
Efectrical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Only)
Mailing Address (Contractor or Owner Performing Installation)
12467 BOOHE AVE S.S V
A o� d Signature (Contractor or Owner Performing Installation) Phone No.
EB-00001A-11 /95 STATE BOARD COPY - SEE I STRUCTIONS ON BACK OF YELLOW COPY