P - 83606� � II�II IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIII IIII
*03923521*
REQUEST FOR ELECTRICAL WSPECTION ��
Minnesota State Board of Electricity � a_.
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800 ��``"�'��
Home Duplex Apt. Bfdg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above ihe work covered by this request. Enter remarks in this space and on the back of ihe white copy only.
SAVER'S SWITGH INSTALLATIOH
Calculate Inspection Fee - This Inspectiar 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. . 50
Alarm/Remote Control
Swimming Pool I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In oate
Special Inspection
Final �
Investigative Fee Z ""
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE OPIIY This request void 18 months from validation date printed in this box.
392-35� � l�
�a 6
JOB NUMBER #9$06000
PLEASE PRINT OR TYPE
Requeit Qa� �� � 98 Rough-in inspection required? ❑ Yes ❑.No Inspection Other Than Rough-In: p' Ready Now ❑ Will Call
,� (You must call the inspector when ready) �S Date Ready: �i
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
00575 GLENCOE ST NE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
Occupant Phone No.
Power Supplier � Address
NSP MPLS OFF` CE
Electrical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Only)
Mailirg Address (Contractor or Owner Performing Installation)
Authoriz ignature ( ntractor or n r ion) Phone No.
EB-00001A-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF VELLOW COPY