P - 83421I�i�� IIII� I�III (IIII IIIII (�I�I (II�I �I�II IIII III�
*03789070�
REQUEST FOR ELECTRICAL INSPECTION ��
Minnesota State Board of Electricity � �°i;
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 the work covered by this request. Enter remarks in this space and on the back of the white cqoy only.
SAVER'S SWITCH IHSTALLATION
Calculate Inspection Fee - This Inspeciion Requesi 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. 15. 50
Alarm/Remote Control
Swimming Pool I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom ` Rou9n-in Date
X Speciallnspection 1 . 50
Final � D, t� rL !y'� �j
Investig � �--� ` / p
THIS IN T AY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validation date printed in this box.
37s-so7� � �� s�
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JOB HUMBER #9706000
PLEASE PRINT OR TYPE
Requesre�16 � 98 Rough-in inspection required? ❑ Yes [MJo Ins ection Other Than Rou h-In: � Read Now
P g y ❑ Will Call
(You must call the inspector when ready) Date Ready: (�j I 1 E� I 9
I, �] licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
01310 HILLCREST DR NE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
ANOKA
Occupant Phone No.
CHARLE� EDWARD PEARSON 571-5948
Power Supplier Address
NSP MPLS OFF'ICE
Electrical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elect Only)
Mailing Address (Contractor or Owner Performing Installation)
or d Signature (Contractor or Owner Performing Installation) ^ Phone No.
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EB-00001A-1 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY