P - 83649� _ �
' IlIIII��IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII REQUESTFORELECTRICALINSPECTION ���
Minnesota State Board of Electncity �
+ 1821 University Ave., Rm. S-128, St. Paul, MN 55104 �..
* 0 3 6 3 9 5 2 3* Phone (612) 642-0800 m����-��
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Cond. Htg. Equip. Water Htr. 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 ot the white copy only.
SAVER'S SWITCH INSTALLATION
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct tee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee I
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps i
Street Ltg./Traffic Sig. Above 200_Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL p
Sign/Outline Ltg. Xfmr. 1 'rJ.��
Alarm/Remote Control
Swimming Pool I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In Date
X Special Ins ection 1. 00
Final p
Investigat r2 ,
THIS INSTALLATIO AY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validation date printed in this box.
363-952� �� L�� � I
/�< �� JOB HUMBER �l9706000
PLEASE PRINT OR TYPE
RequesPJd� 1'� � G,'� Rough-in inspection required? ❑ Yes �(Vo Inspection Other Than Rough-In: � Ready Now ❑ Will Call
, (You must call the inspector when ready) Date Ready '� � 1'� � 9"f
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route NoJ City Zip Code
' 06370 ABLE ST NE FRIDLEY 55432
i Section No. Township Name or No. Range No. Fire No. County
ANOKA
Occupant Phone No.
EARL D SORENSON 571-2035
Power Supplier Address
NSP h[PLS 'OF'FICE
Electrical Contractor (Company Name) Contrector License No. Master Lic. No. (Plant Elect. Only)
ltASTER ELECTRIC CO. , INC. CA01192
I Mailing Address (Contractor or Owner Performing Installation) ,
12467 BOONE AVE S. SAVAGE MN. 55378
Au�zed Sign�iture (Contrpctq or Ow�r Performing Installation) Phone No.
� E�-00001A-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY
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