P - 83672. I Illiil lilll IIIII IIIII IIIII IIIII IIIII IIIII IIII IIII
*03632650*
REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone(612)642-0800
Home Duplex Apt. Bldg. Other: New
Commercial Industrial Farm Remo
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.
SAVER'S SWITCH INSTALLATION
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Addn
Repair
ulate Inspection Fee - This Inspection Request will not be accepted without the conect tee:
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�
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
Speciallnsp i . 0 Da
Final
Investigative � 'O�`�
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.
363-265�] �-,�� �
/5� 5�
JOB NUMBER #9706000
PLEASE PRINT OR TYPE
Request'Qa3E 1'7 � 13 �7 Rough-in inspection required? ❑ Yes �lo Inspection Other Than Rough-In: �
(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
06003 GARDENA CIR NE FRIDLEY
Section No. Township Name or No. Range No. Fire No. County
ANOKA
Occupant
DENNIS J
Power Supplier
CRAFT
Ad�—
Phone No.
Ready Now ❑ Will Call
7/17/97
Zip Code
55432
571-5521
Electrical Contractor (Company Name) Contractor License No.
Mailing Address (Contractor or Owner Performing Installation)
Aut ri ed Si na re (Co r ctor or Owner Performing Installation)
EB-OOOOtA-11 S/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BAC � YELLOW COPY
Master Lic. No. (Plant Elect. Only)
Phone No.