P - 83685I I H I Ij �� I I I I I I I I I I I I I I I( I I I( I I I I( I I I I I I I I I I I I I I I I
t *03633476*
REGIUEST FOR ELECTRICAL INSPECTION ���
Minnesota State Board of Electricity �' a °'°
1821 University Ave., Rm. S-128, St. Paul, MN 55104 �
Phone (612) 642-0800 �`'�; ``s�
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 Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on the back ot the white copy only.
I SAVER'S SWITCH INSTALLATION I
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 � �
Sign/Outline Ltg. Xfmr. 1�� �
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
Speciallnspection ' inal
Investigative Fee .� � � — � --
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validation date printed in this box.
363-347� �
�s�s� � ��� � JOB NU?lHER �970b000
PLEASE PRINT OR TYPE
RequesP�atE 1"j � G3'r Rough-in inspection required? ❑ Yes [�Jo Inspection Other Than Rough-In: � Ready Now ❑ Will Call
(You must call the inspector when ready) Date Ready: '� � 17 � C3'�
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
06517 t1CKINLEY ST NE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
AHOKA
Occupant Phone No.
PAUL KOK 574-1382
Power Supplier Address
NSP MPLS OF'FICE
Electrical Contractor (Company Name) Contractor License No. Master Lia No. (Plant Elect. Only)
Mailing Address (Contractor or Owner Performing Installation)
Authori ignature ( ntracto o wner Performing Ins ti n Phone No.
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� EB-00001A-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY