P - 83707IalII�I�IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII REQUEST FOR ELECTRICAL INSPECTION ���� ,
Minnesota State Board of Electricity �
♦ 1821 University Ave., Rm. S-128, St. Paul, MN 55104 �
* 0 3 6 3 2 9 1 6* Phone (612) 642-0800 ���� -�
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
;" above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
SAYER'S SWITCH 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 TOTAL d�p
Sign/Outline Ltg. Xfmr. 1rJ.
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 1 . 00
Final pNe �
Investigative Fe r- G., —l'o —
_ THIS INSTALLA 10 A ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
....�--.�.�_..�-----r------._____ ... .
_ OFFICE USE ONLY This request void 18 months from validation date printed in this box.
363-291
� ��3��
/ �r� � JOB NUI9BER #69706000
PLEASE PRINT OR TYPE
ttequest-yaye 1-J / y-� Rough-in inspection required? ❑ Yes ❑��lo Inspection Other Than Rough-In: �( Ready Now ❑ Will Call
(You must call the inspector when ready) Date Ready: '� � 1%� 97
I, u licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
00485 RICE CREEK BLV NE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
AHOKA
Occupant Phone No.
JOSEPH GARTHOFNER 571-8439
Power Supplier Address
NSP MPLS OFFICE
Electrical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Only)
Mailing Address (Contractor or Owner Performing Installation)
Authori Signatur (Contract wner Perfo ' g Installation) Phone No.
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-00001A-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY