P - 83320REQUEST FOR ELECTRICAL INSPECTtON °'E
6 9 0 yo �� � Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St, Paul, MN 55104
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� Phone (612) 642-0800 "�''
Home Duplex Apt. Bldg. Other: New Addn
Commercial Indusfrial Farm Remod Re air
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 copy only.
Install switch for bath fan & switch for outlet in
bedroom
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 Am s Above 100 Amps
Transformer/Generptor INSPECTOR'S USE ONLY TOTAL
Sign/Outline Ltg. Xfmr. 2 50
Alarm/Remote Control
Swimming Pool ,
I hereb ceAi ihat I ins cted the elecfrical insfallafion described herein on if�e dales sMfed
Irrigation Boom Rough-In Dare
Special Inspecti
Final ^ 2�
Investigative Fe � �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN f8 MONTHS.
OFFICE USE ONIY 7his request void 18 monlhs from validation date printed in this box.
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* 0 6 9 a Q 2 1 1� 70�(�
9 8 0 6 21 PLEASE PRINT OR TYPE
Request Da1e Rough-in inspecfion required? ❑ Yes ❑ No Inspeclion Other Tlwn RougMn: ❑ Ready Now 0 Will Call
10 / 15 / 9 8 (You musf coll fhe inspector when ready) Dute Ready:
I, � licensed contractor ❑ owner hereby request inspection of the above elechical work at:
Job Address (Sheet, Box, or Route No.) Ciy Zip Code
5422 Madison St NE Fridley
Section No. Township Name or No. Range No. Fire No. County
$��$�a Anoka
Occupant Phone No.
CArol Johnson 572-9221
..o���raaor ��ompany rvame� Conhoctor license No. Masler lic. No. (Plant Elecf. O
American Eagle Electric, In . CA00161
Mailing Address (Contractor or Owner PerForming Installation)
18475 Rum River Blvd NW, Anoka, Mn 55303
Authorized ' nature �ConMOC(or or Owner erforming Insfallafion� � phone No.
� 26587 753--0438
EB-00001 -11 8/96 STATE BOARD COPY - SEE INSTRUCTlOMS ON BACK OF YELlOW COPY