P - 83431I��I��� �III) II�II I�III �Illi IIII� IIIII �III� I�I� I�II R82�1 UEiSersFORve.LRm. SRIC8 St PauPIEMN 5O5N04 ����
Minnesota State Board of Electricity �
* Q 3 7 8 9 1 3 8'� 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:
Dryer Range Elec. Heat emp. 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 Inspeciion Fee - This Inspection Request will noi 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. 50
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
X Specia s ection . 50
Final Da
Investi i d �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.
378-913�] i ,� �
�/3�
,70B HUMHER #97@6000
PLEASE PRINT OR TYPE
Request,Da�16 � 9� Rough-in inspection required? ❑ Yes f"LNo Inspection Other Than Rough-In: p, Ready Now ❑ Will Call
d �t 7t
(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
07399 LYRIC LH NE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
axoxA
Occupant Phone No.
ttICHAEL J SCHREIBER 784-8296
Power Supplier Address
NSP
Elechical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Only)
Mailing Address (Contractor or Owner Performing I�sta lation)
e ignature ( ontrac or or wner Per orming Insta at�on Phone No.
EB-00001A-1 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY