P - 84089II�EII�IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII R8 QU�ESe SFORve.LRm. SR1C8, St PaPEMNION04 �����`;
Minnesota State Board of Electriaty �
'* 0 3 7 1 6 3 6 2* 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 this request. Enter remarks in this space and on the back of the white copy only.
SAVER'S SWITCH IHSTALLATION
�alculate Inspection Fee - This Inspection Requesi will not be accepted wiihout 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 ONLV TOTAL
Sign/Outline Ltg. Xfmr. 15. S0
Alarm/Remote n�rol
Swimming Pool � r j' I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In Date
�{ Special Inspection 1 . S0
Final D e �/
Investigative Fee --Z3� C�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validation date printed in this box.
371-636 �
�j` i���� �
� �7�� JOB NUMBER #9706000
PLEASE PRINT OR TYPE
Requgst,Lla�1,7 / 9,7. Rough-in inspection required? ❑ Yes RAIo Inspection Other Than Rough-In: f.l. Ready Now ❑ Will Call
1 YJ �� 7S
(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 Zip Code
06381 SAUIRE DR NE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
Occupant
Power Supplier � Address
AxoxA
Phone No.
Electrical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Only)
Mailing Address (Contractor or Owner Performing Insta lation)
Aut r i ture ontrac or or wner Pe6r �orming ns a ation Phone No.
�G � �` � �� �'s
EB-00001 - 8/95 STATE BOARD COPV - SEE INSTRUCTIONS ON BACK OF YELLOW COPY 1