P - 83688i .
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Minnesota State Board of Electriaty �
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* 0 3 6 3 3 0 3 9* Phone (612) 642-0800 �'�'�°�j56
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
"' above the work covered by this request. Enter remarks in this space and on the back ot the white copy only.
SAVER'S SWITCH INSTALLATION
Calculate Inspection Fee - This Inspection Request will not be accepted withouf ihe 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 � s�
Sign/Outline Ltg. Xfmr. 15. �
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 Special Ins 00 � te
Final
Investigative Fee -�' - � r
, THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED W HIN 18 MONTHS. �
_____._______�______ _�.____�_____�___.--,�._,_._._._. ------
OFFICE USE ONLY This request void 18 months from validation date printed in this box.
363-3�3� �3� � �
15�, so �
JOB NUtIBER �9706000
PLEASE PRINT OR TYPE
Request'ga� 1'� j�"J Rough-in inspection required? ❑ Yes �lo Inspection Other Than Rough-In: � Ready Now ❑ Will Call
(You must call the inspector when ready) Date Ready: 7� 1'] � 97
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
051'78 MATTERHORN DR NE FRIDLEY 55421
Section No. Township Name or No. Range No. Fire No. County
Occupant
KENNETH L
Power Supplier
Electrical Contractor (Company Name)
HAGEN
Address
AHOKA
Phone No.
S%i-0050
► OFFICE
Contractor License No. Master Lic. No. (Plant Elect. Only)
Mailing Address (Contractor or Owner Performing Installation)
12467 BOONE AVE S.S V M 7
Authoriz Signatu e ontractor r ner erforming Installation) Phone No.
f'
EB-00001A-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY