P - 83701I � I6iIl II IIII� IIIII IIIII IIIII IIIII IIIII IIII IIII R8 Q UESe SFORve LRm SR 1C8 S{NS PEMN ION04
� Minnesota State Board of Electncdy
� * Q 3 6 3 9 7 1 3* Phone(612)642-0800
Home Duplex Apt. Bidg. Other: New
Commercial Industrial Farm Remo
Air Cond. Htg. Equip. Water Htr. 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 SWITCH INSTALLATION
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Calculate Inspeciion Fee - This Inspection Request will not be accepted without the correct fiee:
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 ONLV TOTAL • �
Sign/Outline Ltg. Xfmr. 15. 00
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 i . �0 ,��[-/
Final _�?ts..._�_.. Da� � z ��V
Investigative F
THIS INSTALLATION A ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validation date printed in this box.
363-971 �f # � �� � •
�j�J�� JOB NUMBER �9706000
PLEASE PRINT OR TYPE
Requesf�� 17 � 97 Rough-in inspection required? ❑ Yes �(Vo 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
00125 PILOT AVE FRIDLSY
Section No. Township Name or No. Range No. Fire No. County
ANOKA
Occupant
DUANE A
Power Supplier
NSP
Electrical Contractor (Company Name)
Mailing Address (Contractor or Owner Performing
Phone No.
TYO
Address
MPLS OFFICE
Contractor License No.
Owner Performing Installation)
Ready Now ❑ Will Call
7/17/97
Zip Code
55421
S%2—B%%2
EB-OOOOtA-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY
Master Lic. No. (Plant Elect. Only)
Phone No.