P - 83075I lll���i1111111 Illll Ilill lll{i Illfl Ilill Ilfl flll
'* Q 3 8 6 9 4 7 6*
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 Addn
Commercial Industrial Farm Remod Repair
Air Cond. Htg. Equip. Water Htr. oad 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 INSTALLATIOR
Calculate Inspection Fee - This lnspection Request will not be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # CircuilsfFeeders 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 15. �v�
Sign/Outline Ltg. Xfmr.
AlarmlRemote Control
SWIf1lfT11f1CJ POO� I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In Date
pecial Inspection � Final ce _/ �+
Investigative Fee l(
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
� OFFICE USE ONLY This requesi wid 18 months from validation date printed in this box.
3ss-947 6 � ,s �
5�/�
JOH HUMHER #970600
PI.EASE PRINT OR TYPE
Request Da Rough-in inspection required? � Yes ❑ N Inspection Other Than Rough-In: ❑ ady Now ❑ Will Call
. (You must call the inspector when ready) Date Ready: 8I 1� I J8
I, ❑ licensed contractor ❑ owner hereby request inspection of the above electrical work at:
.bb A��s��re�t' Box, or Ro��) ST HE c'f�R I DLEY Z�P °q�5421
Section No. Township Name or No. Range No. Fire No. ���' ANOKA
��'AMIEI. ROBERT KISHISH �'��N� 571-5481
PowerNuppliPer Address
�5 MPL� OFF'ICE
Electrical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Ony)
!'[ASTER ELECTRIC CO. , INC. CA01192
Mailing Address (Contractor or Owner Performing Installa[ion)
12467 BOONE AVE S. SAVAGE KN. 55378
Authorized Signatu ractor or Owner Performing Installation) Phone No. _
� 94 —47 /
EB-00001A-11 8/95 STATE BOARD COPY • SEE INSTRUCTIONS ON BACK OF YELLOW COPY