P - 83715rI II � III IIIII IIIII IIIII IIIII IIIII IIIII IIII IIII
*03632817*
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
Commercial Industrial Farm Remo
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 ihe back of ihe white copy only.
SAVER'S SWITCH INSTALLATION
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Addn
Repair
ulate 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 Q
Sign/Outline Ltg. Xfmr. 15.��
Alarm/Remote Control
Swimming Pool I hereby certify that I inspected the eiectrical installation described herein on the dates stated
Irrigation Boom Rough-In Date
Speciallnspection i .0ia
Rnal �' te � � . � �
Investigative F
THIS INSTAL ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
. OFFICE USE ONLV This request void 18 months from validation date printed in this box.
363-281 � �
/ # �8 a
f ��� JOB NUMBER �9706000
PLEASE PRINT OR TYPE
RequesYl'�a� 17 � 97 Rough-in inspection required? ❑ Yes �Jo Inspection Other Than Rough-In: � Ready Now ❑ Will Call
(YOU must call the inspector when ready) Date Ready: "J � 1'� � 9']
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
06312 STARLITE BLV NE FRIDLSY 55432
Section No. Township Name or No. Range No. Fire No. County
ANOKA
Occupant
JAKES J
Power Supplier
Electrical Contractor (Company Name)
Mailing Address (Contractor or Owner Performing I
Phone No.
FISCHER
Address
KPLS OFFICE
Contractor License No.
or Owner Performing Installation)
574-5718
EB-00001A-11 8/95 STATE BOARD COPY - SE� II�1STFidCkWg�ON BACK OF YELLOW COPY
Master Lic. No. (Plant Elect. Only)
Phone No.