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*03633013*
Home Dunlex Ar
REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone(612)642-0800
Other: New
Commercial Industrial Farm Remod
Air Cond. Htg. Equip. Water Htr. }{ Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
SAVER'S SWITCH INSTALLATION
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Calculate lnspection Fee - This Inspection Request will not be accepted withoui 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 ��0
Sign/Outline Ltg. Xfmr. 1S.
Alarm/Remote Control
Swimming Pool I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In Date
}( Special Inspec �
_ . . _ _ Final � n.,�„
iivcauyauvc rC� —•rl .� �. I � iC ��_ I r Z �-Z+ �---�/
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.
363-3� 1�
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JOB HUMHER #�9706000
PLEASE PRINT OR TYPE
"cy"c" yaJ'� j-/ /`,j-/ Rough-in inspection required? ❑ Yes �Jo Inspection Other Than Rough-In: I
(You must call the inspector when ready) Date Ready:
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sheet, Box, or Route No.) City
01060 GARDENA AVE NE FRIDLEY
Section No. Township Name or No. Range No. Fire No. County
ANOKA
Occupant
liICHAEL. ALEN HAGEL
Power Supplier Address
Electrical Contractor (Company Name)
Mailing Address (Contractor or Owner Performing
Ready Now ❑ Will Call
7/17/97
Zip Code
55432
— I Phone No.
572-2476
1 �i' l' iCG
Conhactor License No. Master Lic. No. (Plant Elect Only)
Authorize gnature ( o ractor or er Performing Installation) Phone No.
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I EB-00001A-17 8/g5 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY
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