P - 83551i����iii iiiii iiiii iiiii iiiii iiiii iiiii iiii iiii
*03923356*
REQUEST 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
Commerciai Industrial Farm Remod Repair
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat emp. Service
"X" above the work covered by fhis request. Enter remarks in this space and on the back of the white copy only.
SAVER'S SWITCH IHSTALLATION
Calculate Inspection Fee - This Inspection Request will not be accepted wifhout 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. . 50
Alarm/Remote Control
SWIfTIfTli119 POOI - I hereby certi that I ins
fy pected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In Date
X Speciallnspection 1 . 50
Final Dat
Investigative Fee .� -r � — �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
��. �_._.� �,.�.��.-,-.�-,—�f
OFFICE USE ONLY This request void 18 month om validation date printed in this box.
392-33�] �-g���� 1 ��
JOH NUMBER #9�6000
PLEASE PRINT OR TYPE
Reque�t Qay� 30 � c�8 Rough-in inspection required? ❑ Yes ❑�lo Inspection Other Than Rough-In: �{ Ready Now 0 Will Call
(You must call the inspector when ready) Date Ready: 1 S I 30 � S8
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (S[reet, Box, or Route No.) City Zip Code
074?8 JACKSON ST HE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
AxoxA
Occupant Phone No.
DON J CAP'[PIOM 785-6014
Power Supplier Address
NSP MPLS OFFICE
Electrical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Only)
Mailing Address (Contractor or Owner Performing Installation)
Authorized Signature (Contractor or Owner Performing Installation) A n �`� .� PFane No.
h� V
EB-00001A-11 8/95 S7ATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY