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*038698�5*
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 ot the white copy only.
SAVER'S SWITCH INSTALLATION
Calculate Inspection Fee - This Inspection Request will not be accepted without the conect tee:
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. 1S.S0
Alarm/Remote Control
Swimming Pool '
I hereby certify tha[ I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In Date
peciallnspection •
Investigative Fee Final r DatZ_ ,/
��
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.
386-981� � �S
�� �
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: a� 14 / 98
I, ❑`Rcensed contractor ❑ owner hereby request inspection of the above electrical work at:
,lob Address Street, Box, or Route No.) City Zip Code
01�00 �5TH AVE NE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. Counry
ANOKA
Occupant Phone No.
JAY P ROSENTHAL 786-7872
Power Supplier Address
NSP PlPLS OFFICE
Electrical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Ony)
PSASTER ELECTRIC CO. , INC. CA01192
Mailing Address (Contractor or Owner Performing Installation)
12467 BOONE AYE S. SAVAGE MN. 55376
Authorized Sign e ontractor or Owner Performing Installation) Phone No.
�11
EB-00001A-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY