P - 83464����i� ���� ����� ����� ����� ����� ����� ����� (��� ����
*037&9112*
REQUEST FOR ELECTRICAL INSPECTION �r�+E'�
Minnesota State Board of Electricity � 3,
1821 University Ave., Rm. S-128, St. Paul, MN 55104 �
Phone (612) 642-0800 �`'�""
Home Duplex Apt. Bidg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above fhe work covered by fh/s request. Enter remarks in thls space and on the back of the whrte copy only.
SAVER'S SWITCH INSTALLATIOH
Calculate lnspectron Fee - This lnspectron Requesf wil! not be accepted wrthouf 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. lr'J. rJ0
Alarm/Remote Control
Swimmin I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In Date
X Special Inspection i • 5� Finai Date c^
Investigative Fee cRt,�-�-,�--._.-- � � -- �
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.
378-911� � �3�. �
y
JOH NUMBER �t9706000
PLEASE PRINT OR TYPE
Requesr��Z 6 � g� Rough-in inspection required? ❑ Yes �+lo Inspection Other Than Rough-In: � Ready Now ❑ Will Call
(You must call the inspector when ready) Date Ready: �j I S E� I98
I, �] licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
06340 VAN BUREN ST HE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
ANOKA
Occupant Phone No.
IRVIM F SAHLI 574-0136
Power Supplie� Address
NSP MPLS OFFICE
Electrical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Only)
Mailing Address (Contractor or Owner Performing Installation)
A o' d ignature (Contractor or Owner Performing InsTallation) Phone No.
EB-00001A-11 /95 STATE BOARD COPY - SEE INS O ON BACK OF YELLOW COPY