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*03798410*
REQUEST FOR ELECTRICAL iNSPECTION ���,
Minnesota State Board of Electricity � 3-.
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800 �"�` `6^
Home Duplex Apt. Bidg. Other: �..� S� New Addn
Commercial Industrial Farm Remod Repair
Air Cond. Htg. Equip. Water Htr. oad Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above ihe work covered by this request. Enter remarks in thls space and on the back of the white copy onty.
SAVEFt'S SWITCH INSTALLATION
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 oN�v TOTAL .S4
Sign/Outline Ltg. Xfmr. 15.'00'
Alarm/Remote Control
SWIIIIfTtlfl9 POO � I hereby certify [hat I inspected the electrical instaliation described herein on the dates stated
Irrigation Boo aou9n-in Date
peciai Inspection 5. 0
inal D
Investigative Fee � ' Z%�—
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLV This request void 18 months from validation date printed in this box.
379-841� ��,�0 +
lC,�`�� � JOB Nl1MHER �970600
PLEASE PRINT OR TYPE
Request Da� � 19 �,�8 Rough-in inspection required? ❑ Yes ❑ NcX Inspection Other Than Rough-In: ❑�eady Now ❑ Will Call
� (You must call the inspector when ready) Date Ready:
I, ❑}�icensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
001l2 HORI20N CIR NE FRIDLEY 55421
Section No. Township Name or No. Range No. Fire No. Cainty
ANOKA
Occupant Phorte No.
RALPH A GROENKE 667-2667
Power Supplier Address
NSP
Electrical Contractor (Comparry Name) Contractor License No. Master Lic. No, (Plant Elect. Ony)
Mailing Address (Contractor or Owner Performing Installation)
Authorized Si t ( ntractor or Owner rforming In a latio�j� �� O� - Phone No.
�
EB-OOOOtA-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY