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P - 83698i �{lii �II�I IIIII IIIII IIIII IIIII �IIII IIIII IIII I�II *Q3632858* Home Duolex A� 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 Commercial Industrial Farm Remod 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. SAVER'S SWITCH INSTALLATION � � ��� �.;� �!%' Addn Calculate In�oection Fee - This Inspection Request will not be accepted wifhout fhe coneci 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 ONLY TOTAL o�0 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 Inspection 1. 00 Final Da Investigativ� � ^� ,� — � THIS INST I BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS. � OFFICE USE ONLY This request void 18 months from validation date printed in this box. 363-285�] � ��� a �5isb JOB HUMBER �9706000 PLEASE PRINT OR TYPE rsequesiyaye 1-� � y-� Rough-in inspection required? ❑ Yes �(Jo Inspection Other Than Rough-In: Q( Ready Now ❑ Will Call (You must call the inspector when ready) Date Ready: '� �'1'� � 9^J I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at: Job Address (Street, Box, or Route No.) Ciry Zip Code 01344 OSBORHE RD HE FRIDLEY 55432 Section No. Township Name or No. Range No. Fire No. County ANOKA Occupant Phone No. JEANETTE FOI2IE 783-3886 Power Supplier Address NSP MPLS OFFICE Electrical Contractor (Company Name) Contractor License No. Master Lia No. (Plant Elect. Only) Mailing Address (Contractor or Owner Performing Installation) 12467 BOONE AVE S.SAV Autho � Si nat e(Con c r or Owner Performing Installation) Phone No. 25 ` � EB-00001A-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY