P - 81376Iltitlllll I I(I II IIII I I I I I III IIII REQUEST FOR ELECTRICAL INSPECTION tr�sM,�,
Minnesota State Board of Electricity ��q-�.
1821 University Ave., Rm. 5-128, St PaW, MN 55104 � �
•* 0 3 9 2 3 9 4 3* Pno�e�si2�saz-oaoo '�-�• �
Home Duplex Apt Bldg. Other: New Addn
[�I
Farm Remc
Water Htr. Load M9mt Other:
Elec. Heat Temp. Service
requesG Enier remaiks in this space and on the 6ack ol Ihe white copy alty.
SAVER'S SWITCH INSTALLATION
ulafe Inspection Fee - Th�s Inspection Request will not be accepfed withouf the carect /ee:
Other Fee u 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
TransformeNGenerator INSPECTOR'S USE ONLV TOTAL. i
Xfmr.
CzI�i7
n iy rvm I hereby cer�ify �hat I'mweototl ihe electrical installaM1Or cesoribetl hereln on ihz tlates statetl
Irrigation Boom Fough-In Da�e
x c ii t �rn
v�vvV••••Vryv,v Final � Ie
Investigative Fee � -- �%• 7 0—�i q
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS~
OFFICE USE ONLV This reques� witl 18 mon[hs from valitlation date pnntetl in thls box.
392-39�3 • �.s, ,v
/a6
30H NUMHER it9�j0600�d
PLEASE PRINT OR TYPE
Requeit ie1f 30 / 9ti Aoueh-fn irisoecuon reauired7 p ves p]�o msaoaion omer rnan Rwen-�o [p( Reaav Now p wm cel�
(uou must cau me Inepeoror wnen reacv> oate asacy 1 1/-3 @/ 9�
I, � lieensed contractor ❑ owner hereby request inspeetion ot the a6ove elecirical work at
Job Atltlress (Shcet Box, or Route Na_) Gity Zip Coas
05687 W BAVARIAN YAS FRIDLEY 55432
Sec�ion No. Township Name or No. Renge Na Fire M1o. Cowry
ANOKA
Occupanl
BRUCE F
Power Suppller
Namej
Atldress�COnhaclor or
POMERANTZ
Cqnh2clor Licen'e No-
Phone No.
296-6239
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EB-00001A-11 8.�95 STATE BOARD COPY - SEE INSTfiUCTIONS ON BACK OF YELLOW COPV
Elect Ony)