P - 83689� xi Ifllll IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIII IIII
*03638970*
REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone(612)642-0800
Other: New
;ommercial Industrial Farm �emc
air Cond. Htg. Equip. Water Htr. K Load Mgmt. Other:
)ryer Range Elec. Heat Temp. Service
above the work covered by this request. Enter remarks in this space and on the back of the white cqoy only.
SAVER'S SWITCH INSTALLATION
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' Addn
Repair
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 Q
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
THIS INSTALLATION MAY
363-897�]
PLEASE PRINT OR TYPE
Final Dat
_.�-% a /`�� 7
ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validation date printed in this box.
�� �80
�55 � JOB NUMBER �9706000
RequesY➢a�E 1'� � C,'� Rough-in inspectlon required? ❑ Yes [�Jo I Inspection Other Than Rough-In: [
(You must call the inspector when ready) Date Ready:
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City
05600 I7ATTERHORN DR NE FRIDLEY
Section No. Township Name or No. Range No. Fire No. County
ANOKA
Occupant
MARTHA M
Power Supplier
Electrical Contractor (Company Name)
Mailing Address (Contractor or Owner Performing
Phone No.
NYHUS
Address
MPLS OFF'ICE
Contractor License No.
Ready Now ❑ Will Call
7/17/97
Zip Code
55432
566-0763
Master Lic. No. (Plant Elect. Only)
Authorize i n tur Contr t or Owner Perfopyin��latp,yi) � Phone No.
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EB-OOOOtA-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY