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*03797958*
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 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 SWTTCH INSTALLATION
Calculate Ins,oeciion Fee - This Inspection Request will not be accepied 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 15.
Sign/Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool f hereby certify that 1 inspected the electrical installation described herein on the dates stated
rigation '� ough-In Date
pecial I pe ti • Final Date
Investigative Fee / 'Z —2-1'
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.
379-795�] � � , �
��
JOB NUMBER �970600
PLEASE PRINT OR TYPE
Request Da Rough-in inspection required? ❑ Yes ❑ N Inspection Other Than Rough-In: ❑ dy Now ❑ Will Call
(You must call the inspector when ready) Date Ready: E�/ S 9/ 98
I, ❑ licensed contractor ❑ owner hereby request inspection of the above electrical work at:
�°b'°`��s�`�, B°", °` R`�`l�'!> ST NE O1yFRIDLEY zip c°�5421
Section No. Township Name or No. Range No. Fire No. County pNOKA
°ocip�RtICHAEL C ANDERSON PhoneNo. SB6-07,�7
Power Sup lier Address
NS�P MPLS ORFICE
Electrical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Ony)
KASTER EL.ECTRIC CO. , INC. CA01192
Mailing Address (Contractor or Owner Performing Installation)
12467 BOONE AVE S. SAYAGE KN. 553'78
Authorize Si nature (Contractor or Owner Performing Install�)/� A�� Phone No.
tiV 94 —4712/890-355
EB-OOOOtA-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY