P - 84069�' ���iNiIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIiIII REQUEST FOR ELECTRICAL INSPECTION ����
Minnesota State Board of Electriciry �
� 1821 University Ave., Rm. S-128, St. Paul, MN 55104 -�
* 0 3 7 1 6 9 3 3* Phone (612) 642-0800 �"�"
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Oryer 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 INSTALLATIOH
Calculate Inspection 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 ONLV TOTAL
Sign/Outline Ltg. Xfmr. 15. 50
Alarm/Remote Control
Swimming Pool `+r"" ) I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom �x � Rough-In Date
X Special Inspection i. S0 � c- ,
Final —
Investigative Fee " ��k �'` �� ' 3 � �
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.
371-693 � � �
� �
� ���� JOB NUMBER #9706000
PLEASE PRINT OR TYPE
Requ�t��qel'J � C�7 Rough-in inspection required? ❑ Yes [�Jo Inspection Other Than Rough-In: j� Ready Now ❑ Will Call
(You must call the inspector when ready) Date Ready: 10I �. % I J%
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
01654 KRISTIN CT FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
ANOKA
Occupant Phone No.
TIM D SOLBERG 571-4105
Power Supplier Address
Electrical Contractor (Company Name) Contractor License No. I Master Lic. No. (Plant Elect. Only)
Mailing Address (Contractor or Owner Performing
(Contractor or
8/95 STATE BOARDL`O�T -�E�N�iUCTIONS ON BACK OF YELLOW COPY
Phone