P - 83548�1�1111111IIIII IIIII IIIII Ilill IIIII IIIII IIII IIII
*03923349*
REQUEST FOR ELECTRICAL INSPECTION �,�r��,
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. }� Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the wo�k covered by this request Enter remarks in this space and on the back oi the white copy only.
SAVEF{'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. ��. 50
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 Insp i r'� �, 50
Final D e
trrvestigative e — 2 ---
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
- - � r..r..�.�..._�_r--.r—r—��.•�-----r--�--�'--"--
.. ... .... .... . _ . . . �
E ONLY This request void 18 months from validation date printed in this box.
392-33 �'�-� � S :� �
30B HUMBER #9�06000
PLEASE PRINT OR TYPE
Reque�t �atf 30 / 98 Rough-in inspection required? ❑ Yes ❑ROo Inspection Other Than Rough-In: [K Ready Now ❑ Will Call
(You must call the inspector when ready) Date Ready: �
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
.bb Address (Street, Box, or Route No.) City Zip Code
08330 BROAD AVE NE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
ANOKA
Occupant Phone No.
STEPHEN L BROWH 780-9087
Power Supplier Address
NSP 1'i'iPLS OFFICE
Electrical CoMrador (Company Name) Contractor License No. Master Lic. No. (Plant Eled. Only)
ltASTER ELECTRIC CO. , INC. CA01192
Mailing Address (Contractor or Owner Performing Instailation)
1�467 BOONE AYE S.SAVAG N. 5537A
Authorized Signature (Contractor or Owner Performing Installation) � y I' � Phone No.
EB-00001A-11 8/95 STATE BOARD COPY - SEE INS7RUCTIONS ON BACK OF YELLOW COPY