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