P - 82891RECIUEST FOR ELECTRICAL INSPECTION
� �. � � � � � � Minnesota St �e Board of Electricity
1821 Universi Ave., Rm. S-128, St. Paul, MN 55104
Phone(612)642-0800
X Home Duplex Apt. Bldg. Other: New
Commercial Industrial Farm Remod
X 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 ihe white copy
Calculate Inspection Fee - This Inspection Request will not be accepted without ihe correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Am s Above 100 Am
Transformer/Generator INSPECTOR'S USE ONLY TOTA
Sign/Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
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Fee
15.50
1 heceb certi tlwt 1 i� the elednccd installahon descri6ed herem on ihe dates �����+
Irrigafion Boom RougMn �
Special Inspec ' p
Final
Investigative F
THIS INSTALLATION MAY BE ORDERED DI ECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFRCE USE ONLY This request void 18 months from validafion date printed in this box.
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PLEASE PRINT OR TYPE
Request Date 5�`L$—CJ8 Rouglrin inspecfion required? ❑ Yes
[i�No Inspeclion Ofher Than RougMn: �Ready Now ❑ Will Call
�`/ou must rnll the inspector when ready) Date Ready:
I, � licensed confractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Sfreet, Box, or Route No.) Ciy Zip Code
4953 Roman Rd Fridley 55421
Section No. Township Name or No. Range No. Fire No. County
Anoka
Occupant Phone No.
Red Sandvold 572-8679
Power Supplier Address �
dracfor �Company Name) Conhacfor License No. Mas�er lic. No. (Plant Elec
Electric Inc CA02749
ess (Conhador or Owner Performing Installation�
9 d Ln NE Blaine MN 5 �
re (Conhacror or Owner rming Insfall 'on) � Phone No.
t 786-8484
I 8/96 TATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY �