P - 84052I I�IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII REQUESTFORELECTRICALINSPECTION ���
Mmnesota State Board of Electncity � p
1821 University Ave., Rm. S-128, St. Paul, MN 55104
� * 0 3 7 1 6 1 4 9* Phone (612) 642-0800 �`�°'�
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Cond. Htg. Equip. Water Htr. X 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 cqoy only.
SAVER'S SWITCH INSTALLATIObI
Calculate Inspection 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 ONLV TOTAL
Sign/Outline Ltg. Xfmr. 15. 50
Alarm/Remote Control
""- _
SWlfllflllllg POOIC I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In �ate
X Speciallnspection 1 . 50
Final . Date
Investigative Fee c`3 `7'.S"
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.
371-614 [� # � �, � �
� ���
JOB NUMBER �M970b000
PLEASE PRINT OR TYPE
Requ�t,l�a�1,7' 9,., Rough-in inspection required? ❑ Yes f"kPlo Inspection Other Than Rough-In: fa. Ready Now ❑ Will Call
VJ 1L �i
(You must call the inspector when ready) Date Ready: 10 � 1•7 � 9•1
I, $] licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sheet, Box, or Route No.) City Zip Code
00124 GLEN CREEK RD NE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
Occupant
Power Supplier � Address
ANOKA
Phone No.
��a_
Electrical Contractor (Company Name) � Contractor License No. � Master Lic. No. (Plant Elect. Only)
or
Phone No.
1 8/95 STATE BOARD COPY - SEE INS7RUCiTONS�N BACK OF YELLOW COPY