P - 83699� IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII IIIIIIII REQU�ESe SFORve.LRm. SR'C8, StNPaPEMNI5O5N04 ����
III�III I Minnesota State Board of Electnaty �
i a v
� * * Phone (612) 642-0800 �"�� "�s
03632551
Home Duplex Apt. Bldg. Other: New Addn
o,..,.,�.
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 of the white copy only.
SAVER'S SMtITCH INSTALLATION
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 TOTAi 5 r�Q
Sign/Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool I hereby ceriify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In Date
}t Speciallnspection 1.00 Final Dat �
Investigative e"" r w � — �
THIS INSTA A O A E ORDERED DISC ECTED IF NOT COMPLETED WITHIN 18 MONTHS.
��s�^' �^ OFFICE USE ONLY This request void 18 months from validation date printed in this box.
363-255�] .� ���
/Jri�b JOB NUMBER �9?06000
PLEASE PRINT OR TYPE
Request a� Rough-in inspection required? ❑ Yes ❑�lo 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
00961 PANDORA DR NE FRIDLEY
Section No. Township Name or No. Range No. Fire No. County
ANOKA
Occupant
PAUL V
Power Supplier
Elechical Contractor (Company Name)
BRUCE
Address
Phone No.
� OFFICE
Contractor License No.
Ready Now ❑ Will Call
7/17/97
Zip Code
55432
572-9813
Master Lic. No. (Plant Elect. Only)
Mailing Address (Contractor or Owner Performing Installation)
Autho � e Sign tur (Contra r Owner Performing Installation) � Phone No.
EB-OOOOtA-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY