P - 83420, -1�I�IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII
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REGlUEST 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 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 the white copy only.
SAVER'S SWITCH INSTALLATION
Calculate Inspection Fee - This Inspection Requesi will not be accepted wiihout 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. 1 S. 50
Alarm/Remote Control
Swimmi P I I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigatio Rough-In Date
}{ Speciallnspection . 50 . p
Final Q�`
Investigative Fee •.--v T_
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.
378-895�] � �s �
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JOB NUMBER #t9706000
PLEASE PRINT OR TYPE
Request.Ba�:16 � 98 Rough-in inspection required? ❑ Yes �lo Inspection Other Than Rough-In: j� Ready Now ❑ Will Call
b
(You must call the inspector when ready) Date Ready:
I, g] licensed contractor ❑ owner hereby request inspection ot the above electrical work at:
Job Address (Street, Box, or Route NoJ Ciry Zip Code
Q►5794 HACKMAHN AVE HE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
ANDKA
Occupant Phone No.
DONALD KERNER 571-3720
Power Supplier Address
N�P MPLS OFFICE
Electrical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Only)
Mailing Address (Contractor or Owner Performing Insta lation)
t ized Signature (Contractor or Owner Performing InsJallation) Phone No.
� � �
EB-00001A- 1 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY