P - 84118�I (NI� (III) (IIII IIII) IIIII IIII) IIIII IIIII III) IIII
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REQUEST FOR ELECTRICAL INSPECTION ��
Minnesota State Board of Electricity � °i
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. X Load 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 INSTALLATION
Calculate In�oection Fee - This Inspection Request will not be accepted without the correct fee: I
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee I
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Amps Above 100 Amps I
Transformer/Generator INSPECTOR'S USE ONLY TOTAL '
Sign/Outline Ltg. Xfmr. 15. 50
Alarm/Remote Control
Swimming Po �� I I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In Date
}{ Special Inspection 1 . J0
Final Date c�
Investigative Fee � �—� �°�a
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.
371-s� o � f�.�
/C.'�(�'��/ JOB NUMBER �9706000
PLEASE PRINT OR TYPE '
Requ�t�ale17 � 97 Rough-in inspection required? ❑ Yes �Jo Inspection Other Than Rough-In: � Ready Now ❑ Will Call �.
(You must calltheinspector when ready) Date Ready: �
I, �] licensed coMractor ❑ owner hereby request inspection of the above electrical work at: I�
I
Job Address (Street, Box, or Route No.) City Zip Code I
00105 71 1/2 WAY NE FRIDLEY 55432 '
Section No. Township Name or No. Range No. Fire No. County �
ANOKA '�
Occupant Phone No. II
JULENE K ANDERSON 571-6212
Power Supplier Address I
NSP MPLS OFFICE
Electrical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Ony) I
ltASTER ELECTRIC CO. , INC. CA01192
Mailing Address (Contractor or Owner Performing Installation)
12467 BOONE AVE S.SAVAGE MN SS 7
Aut ' nature (Contractor or Owner Performing Installation) Phone No.
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EB-00 1A 1 8/95 STATE BOARD COPY - S I TRU ONS ON BACK OF YELLOW COPY �