P - 81345I�I�II IIIII I IIII III IIII II I II I II REQUEST FOR ELECTRICAL INSPECTION ��
Minnesota State Board of Electricity ���".
1821 University Ave., Rm. S-128, St. Paul, MN 55104 � ��
* 0 3 9 2 3 6 3 8* Phone(612)642-0800 ����-
Home Duplex Apt. Bldq. Other: New Addn
mt. � pther:
rvice
space and on the back o� [he white copy
SAVEk'S SWITCH INSTALLATION
CalCUlafe Inspection Fee - This Inspecti0.n Request will not 6e acceptetl without fhe covecf /ee:
OMer Fee � ServiCe EntranCe Sire Fee � CirCUits/Feetlers Fee
Mobile Home Park S}all 0 to 200 Amps 0 to 100 Amps
Street LtgJTraffic Sig. Above 200_Amps Above 100_Amps
TransformeNGenerator INSPECTOWS USE ONLY TOTAL
Siqn/Outline Ltq. Xfmr. tlir 501
"'y I hereby cerlly [hzt I mspeded Ae elecirwel installetion tlescribed M1erein on [he dales sfetetl
Irrigation 00(11 Rough-In Date
Speciallnspection F���ei o�� C
InvestigativeFee � � _ z.d �-(
THIS INSTALLATION MAY BE ORDERED �ISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFPICE USE ONLV This reduest void 18 months fmm valitlation tlate pnntetl in ihis box.
392-363� • /S�
/026
JOB NUMBEk #9a0600Q�
PLEASE PRINT OR TYPE
Reque�' pa� 3� /�� RwgMin inspection required? 0 Yes �.IJO Inspec�ion Other Than Rough-In: f�. ReadL Now � 1Vill Call
11 1S T
(YOU musi cell ihe inspector when ready] Date Reatly.
I, � licensed contractor ❑ owner hereby request inspection of the a6ove electrical work at
Jab Atltlress (3Vest, Bax, or Hwte No-) Ctty Lp Gotls
0°�251 MATTERHC�RN DR NE FRIDLEY 55421
Secfmn No. Township Name or No. Range No. Flre Na. Counry
ANOKA
Occupar�t Phone No.
❑EAN
�dres�
or
ConVacror License No. � Master Llc. No. (Plant Elec[ Orly)
E8-00001A-11 8i95 STATE 80AR� COPV � SEE INSTRIICTI0N5 ON BACK OF YELLOW WPV