P - 83085IiI��I III�I IIIII IIIII III�) IIII� IIIII IIII) II�I IIII
*03869542*
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. ad 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 copy only.
SAVER'S SWITCH INSTALLATION
Calculate 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
Sign/Outline Ltg. Xfmr. 15. �0
Alarm/Remote Control
Swimming Poor � I hereby certify that I inspected the electrical installation described herein on the dates stated
II'flgBflOf1 BOO � Rough-In Date
pecial Inspection 15. 0 Finai 3
Investigative Fee �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MON S.
OFFICE USE ONIY This request void 18 months from validation date printed in this box.
386-954 /�'
� �
5���
JOB NUMBER �970600
PLEASE PRINT OR TYPE
Request Da / Rough-in inspection required? ❑ Yes ❑ No Inspection Other Than Rough-In: ❑�ady Now ❑ Will Call
(You must call the inspector when ready) Date Ready: 8� 1, t} I 98
I, ❑�ensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address Street, Box, or Route No.) City Zip Code
00�32 b9TH PL NE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
ANOKA
Occupant Phone No.
ERTC J LARSON 586-0684
Power Supplier Address
NSP MPLS OFFICE
Electrical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Only)
KASTER EC.ECTRIC CO. INC. CA01192
Mailing Address (Contractor or Owner Performing Installation) �
Authorized Signatur ( ractor or Owner Performing Installation) Phone No.
� V
EB-00001A-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY