P - 83423II�II�IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII R8 Q UESe SFORVELRm. SR1C8, StNP PEMNIONo4 ����,
Minnesota State Board of Electnaty �'y �'
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* 0 3 7 8 8 9 3 2'r rnone �e i z� e4z-�av� --
Home Duplex Apt. Bidg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Cond. Htg. Equip. Water Htr. X Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
SAVER'S SWITCH INSTALLATION
Calculate Inspection Fee - This Inspection Request wil/ not be accepied without the conect tee:
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. i`�J' . 'rJ0
Alarm/Remote Control
Swimming Pool I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In Date
}{ Special Insp cti n 1. 50
Final Date
Investigativ ---_--� � ^ 6^.
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.
378-893�] � ,s, �
�/3 �
JOB NUMBER #9706000
PLEASE PRINT OR TYPE
Request�a� 16 � 98 Rough-in inspection required? ❑ Yes �lo Inspection Other Than Rough-In: j� Ready Now ❑ Will Call
(You must call the inspector when ready) Date Ready:
I, $] licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
06729 KENHASTON DR NE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
AHOKA
Occupant Phone No.
FLOYD A JOHNSON S'71-1405
Power Supplier Address
NSP p
Electrical Conhactor (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Only)
Mailing Address (Contractor or Owner Performing Insta lation)
ho � ed Signature (Contractor or Owner Performing Installation) Phone No.
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EB-00001A-1 8/95 STATE BOARD COPY - SEE INSTRUCTIONS i5 BACK OF YELLOW COPY