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*03798$81*
REQUEST FOR ELECTRICAL INSPECTION ���
Minnesota State Board of Electricity � �
1821 University Ave., Rm. S-t28, St. Paul, MN 55104
Phone (612) 642-0800 �'�`'°�%�
Home Duplex Apt. Bldg. Other: �� S C New Addn
Commercial Industrial Farm Remod Repair
Air Cond. Htg. Equip. Water Htr. oad Mgmt. Other:
Dryer Range Elec. Heat emp. Service
"X" above the work covered by this request Enter remarks in this space and on the back of the white cqoy only.
SAVER'S SWITCH INSTALLATiON
Calculate Inspection Fee - This Inspection Request will not be accepted without the conect fee:
Other Fee # Service Entrance Size Fee � Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL s0
Sign/Outline Ltg. Xfmr, j, �'j. �
Alarm/Remote Control
Swimming Pool I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rou�,-i� Date
peciallnsp ti
��a� o
Investigativ — r-
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validation date printed in this box.
379-888�]
/� �5� �� �y
JOB AIUMBER �970600
PLEASE PRtNT OR TYPE
Request Da� � 19 � 9$ Rough-in inspection required? Yes aK �
❑ ❑ N Inspection Other Than Rough-In: ❑ ady Now ❑ Will Call
(You must call the inspec[or when ready) Date Ready:
I, ❑j{censed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
06171 TRIRITY DR NE FRIDLEY 55432
Section No. Township Name a No. Range No. Fire No. County
Axoxn
Occupant Phone No.
DAVID G W AARD -
Power Supplier Address
NSP liPLS OFFICE
Electrical Contractor (Comparry Name) Contractor License No. Master Lic. No. (Plant Elect. Onlyj
Mailing Address (Contractor or Owner Performing Installation)
Authorized Signatu ntractor or Owner Performing Installation) � i Phone No.
CJ
EB-00001A-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OP YELLOW COPY