P - 83025�(I�II��III I�III IIIII IIIII IIII� I�III IIIII �III (�II 182�1 UEiSersFORve.LRm. SR iC8, StNP PEMN ION04 �:����`�
Minnesota State Board of Electricity �
�' * 0 3 8 0 4 2 9 1 i` Phone (612) 642-0800 �����
Home Duplex Apt. Bldg. Other: �� S� New Addn
Commercial Industrial Farm Remod Repair
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat emp. Service
"X" above the wo�k covered by this request. Enter remarks in this space and on the back ot the white copy only.
SAVER'S SWITCH IHSTALLATION
ulate lnspeCtion Fee - This Ins,oection Request will not be accepted wi[hout the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stalf 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 ( S'� �
Sign/Outline Ltg. Xfmr. }{�;—�
Swimming P " " •
I hereby certify that I inspected the electrical installafion described herein on the dates stated
Irrigation Boom Rough-In Date
}{ Special Inspection , 5
Final DatCj '
Investigative Fee ...� �
_ 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 thls box.
380-429�1
,� �5319�
�� �
JOB NUMBER �9706000
PLEASE PRINT OR TYPE
Request p�t� 07 / 98 Rough-in inspection required? ❑ Yes ❑ No Inspection Other Than Rough-In: I-L.Ready Now ❑ Will Cali
/ li 1S
(YOU must call the inspector when ready) Date Ready:
� a�--�� o���
I, [� licensed contractor ❑ owner hereby request inspection of the above e{ectrical work at:
Job Address (Street, Box, or Route No.} City Zip Code
07421 JACKSON ST HE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
Phone No.
Power Supplier � Address
(Company Name)
EB-00001A-11 S/95 STATE 60ARD COPY - SEE INSTRUCTIOI�S CM 6�CK OF YELLOW
Master Lic. No. (Poani Elect. �ly)
Phone No.