P - 83432�! I�I`i� IIIII IIIII NIII INII IIIII NIII IIIII IIII illl
*03788890*
REQUEST FOR ELECTRICAL INSPECTION ��
Minnesota State Board of Electricity �� °'
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800 �`��'e
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 Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on the back of the white cqoy 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 ONLY TOTAL
Sign/Outline Ltg. Xfmr. 1�J. 50
Alarm/Remote Control
Swimming Pool I hereby certify that I inspected the elechical installation described herein on the dates stated
Irrigation Boom Rough-In Date
X Spec'al s ection 1. 50
Final ' a� �
Inv �J
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLV This request void 18 months from validation date printed in this box.
378-889�] i ,5 .,�
�/3 �
30B HUMBER �t9706000
PLEASE PRINT OR TYPE
Request�a�16 � 98 Rough-in inspection required? ❑ Yes [�Jo Inspection Other Than Rough-In: [� Ready Now ❑ Will Call
(You must call the inspector when ready) Date Ready: �j I.�. G I98
I, �] licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
07517 LYRIC LN NE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
ANOKA
Occupant Phone No.
E'RANK R GAMS 786-5683
Power Supplier Address
H�p MPLS OFF'ICE
Elechical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Only)
Mailing Address (Contractor or Owner Performing Installation)
1
A ri d Signature (Contractor or Owner Performing Installation) Phone No.
�
EB-00001A-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY