P - 83554,I IIIIli11111 IIIII IIIII IIIII Illil Illli lilil IIII llil
� *03923398*
REQUEST FOR ELECTRICAL INSPECTION ��°�,,
Minnesota State Board of Electricity -� `"
1821 University Ave., Rm. S-128, St. Paul, MN 55104 �. ,�
Phone (612) 642-0800 '�`y'"
,`"�.r
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Cond. Htg. Equip. Water Htr. X Load Mgmt. Other:
Dryer Range Elec. Heat emp. Service
"X" above ihe work covered by this request. Enter remarks in this space and on the back ot the white cqoy only.
SAVER'S SWITCH INSTALLATION
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct 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 ONLV TOTAL
Sign/Outline Ltg. Xfmr. . 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
K Special Inspection 1. 50
Investigative F ►� •� r.,, Final D� _,Z,Z� P, �/
THIS INSTALLATION ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
......�___._ ,. -.--__-------------- ---_`-____ _ �v.-�_- . �—._�
OFFICE USE ONLY This request void 18 months from validation date printed in this box.
392-33�3] �.����� � ��
JOB NUMBER �'�@16000
PLEASE PRINT OR TYPE
Reque�t iat� �0 � 98 Rough-in inspection required? 0 Yes ��o Inspection Other Than Rough-In: [x Ready Now � Will Call
(You must call the inspector when ready) Date Ready: 1 � �
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Z'ip Code
04020 MAIH ST RE FRIDLEY 55421
Section No. Township Name or No. Range No. Fire No. County
ANOKA
Occupant Phone No.
FORREST CORNELIUS 7B8-6770
Power Supplier Address
NSP MPLS OFFICE
Electrical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Only)
Mailing Address (Contractor or Owner Performing Installation)
Authorized Signature (Contractor or Owner Performing Instal n) Phone No.
�G � �'°
EB-00001A-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY