P - 84729REQUEST FOR ELECTRICAL INSPECTION -
4� V�- 3 0 6 Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800
Home X Duplex Apt. Bldg. Other: New Addn
Commercial I�dustrial Farm Remod g Re air
Air Cond. Htg. Equip. Water Htr. 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 of the white copy only.
Mast
Calculate Inspection Fee - This Inspection Request will not be accepted without fhe correct fee:
Other Fee # Service Entrance ize Fee # Circuits/Feeders Fee
Mobile Home Park Stall 1 0 to 200 Amps 25 . 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
Sign/Oudine Ltg. Xfmr. 25. 50
Alarm/Remote Control
Swimming Pool
I hereby certi(y that � inspected the electrical insfallation described herein
Date
Special Ins
Investigafive Fee F�oal � _��__ p�` �� ,..7
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFlCE USE ONLY This request void 18 months from validation date printed in fhis box.
K � '�U � �
I� II III II III II III II I� �� III II III II III II U� I llll ��� s�
* � 4 � 5 3 � 6 2* PLEASE PRINT OR TYPE
Request Dafe Rougl�in inspection required? ❑ Yes
� No Inspecfion O�er Than Rough-In: � Ready Now ❑ Will Call
7-23-97 (You musf call the inspector when ready) Dafe Ready:
I, [� licensed confractor ❑ owner hereby request inspection of the above elecfrical work at:
lob Address (Sheet, Box, w Route No.) Cify Zi Code
P
7837/7833 Firwood Way Fridley 55432
Section No. Township Name or No. Range No. Fire No. County
o«�,��t
Mark Abraham
Power Supplier
NSP North Division
Elecfrical Confrador �Company Name)
Mailing Address (Conhacfor or Owner Performing Installation)
15377 92nd Ln NF.�. Blaine MN
♦
Anoka
Phone No.
571-8681
3115 Centre Point Dr Roseville MN 55113
Conhactor License No. Master Lic. No. IPlant Elect_ Onlvl
449
.—
CA02749
Phone No.
786-8484