P - 83452, I lII�I! �IIII IIII! IlIII IIIII IIlII IIIII IIlII I!I! I!I!
*03788973*
REQUEST FOR ELECTRICAL INSPECTION ��
Minnesota State Board of Electricity � �'
1821 University Ave., Rm. S-128, St. Paul, MN 55104 �. -
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
"X" above the work covered by ihis request. Enter remarks in this space and on the back of the white copy only.
SAVER'S SWITGH INSTALLATION
Calculate Inspeciion 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
Sign/Outline Ltg. Xfmr. 1S. 50
Alarm/Remote Control
Swimming P I I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Bo Rough-In Date
X Special Inspection 1. J0
Final D
Investigative Fee C% %Z— r
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLV This request void 18 months from validation date printed in this box.
378-897� ! �s �-�
yi3 �
JOB NUMBER #9706000
PLEASE PRINT OR TYPE
Requesf�aJ�16 � 98 Rough-in inspection required? ❑ Yes [MJo Inspection Other Than Rough-In: [� Ready Now � Will Call
(You must call the inspector when ready) Date Ready:
I, �{j licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
01544 S TIMBER RDG FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
AHOKA
Occupant Phone No.
LAURA K LOPER 572-9869
Power Supplier Address
Electrical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Only)
Mailing Address (Contractor or Owner Performing Insta lation)
or' ture (Contractor or Owner Performing Installation) Phone No.
'i
EB-00001A-11 /95 STATE BOqRD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY