P - 82817IIII!1 �III IIIII IIIII IIIII IIIII IIIII Illll IIII IIII
*03797974*
REQUEST FOR ELECTRICAL INSPECTION �,��
Minnesota State Board of Electricity � `"
1821 University Ave., Rm. S-128, St. Paul, MfV 55104
Phone (612) 642-0800 �"�'�
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Cond. Htg. Equip. Water Htr. ad Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this requesL Enter remarks in this space and on the back of the white copy only.
SAVER'S SWITCH INSTALLATION
Calculate Inspection Fee - This Inspection Request will not be accepted without the conect 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 �-
Alarm/Remote Control
Swimming Po I hereby certiy that 1 inspected the electrical installation described herein on the dates stated
Irrigation Boom Rough-Jn Date
pecial Inspection
Final �- D Q r (`/
Investigative Fee � %+�'— �O
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.
379-797� . �S �
.x�97
JOB NUMBER �970600
PLEASE PRINT OR TYPE
Request Dai� � 1 t3 � C3$ Rough-in inspection required? ❑ Yes ❑ No}{ Inspection Other Than Rough-In: ❑ F�ady Now ❑ Will Call
(You must call the inspector when ready) oate Ready: (� / 19 j t38
I, ❑�censed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Atldress (Street, Box, or Route No.) City Zip Code
05179 HORIZON DR NE FRIDLEY 55421
Section No. Township Name or No. Range No. Fire No. County
ANOKA
Occupant . Phone No.
BRUCE M BAILEY 571-9126
Power Supplier Address
NSP MPLS OFFICE
Electrical Contractor (Comparry Name) Contractor License No. Master Lic. No. (Plant Elect. Ony)
ER EG CO 0
Mailing Address (Contractor or Owner Performing Installation)
12467 BOONE AVE S. V 7
Authorized Sig a (Con[ractor or Owner Performinglnstallation) � M! Phone No.
�
EB-OOOOtA-11 S/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY