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*03869351*
REQUEST FOR ELECTRICAL INSPECTION �
Minnesota State Board of Electricity �-
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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. oad Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above ihe work covered by this requesf. Enter remarks in this �oace and on the back of the white cqoy only.
SAVER'S SWITCH ITISTALLATION
Ca/culate lnspeciion Fee - This Inspection Request 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. �0
Alarm/Remote Control
Swimming Pool I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Raigh-In Date
peciallnspection 15.0
Investigative Fee ina� oat . Z �p
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
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OFFICE USE ONLY This request void 18 months from validation date printed in this box.
386-935� � �S �
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JOB HUMBER �970600
PLEASE PRINT OR TYPE
Request Date. � 1�4 ��8 Rough-in inspection required? ❑ Yes ❑ NoX Inspection Other Than Rough-In: ❑ f�ady Now ❑ Will Call
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(YOU must call the inspector when ready) Date Ready:
I, ❑ jljcensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
06350 JEFFERSON ST NE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
ANOKA
Occupant Phone No.
HENRY A EGGERT 574-1510
Power Supplier Address
NSP PiPLS OFFICE
Electrical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Only)
Mailing Address (Contractor or Owner Performing Installation)
Authorized Sign ntractor or Owner Performing Installation) Phone No.
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EB-00001A-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY