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*03798048*
RE(�UEST 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 � U �� Remod Repair
Air Cond. Htg. Equip. Water Htr. oad Mgmt. Other:
Dryer Range Elec. Heat emp. Service
"X" above ihe work covered by this request. Enter remarks in this space and on the back of the white copy only.
SAVER'S SWITCH INSTALLATIOH
Calculate Inspection Fee - This Inspection Request will not be accepted withouf the cwrect 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 sr}
Sign/Outline Ltg. Xfmr. 15. �
Alarm/Remote Control
Swimming Pool I hereby certify that I inspected the electrical installa[ion described herein on the dates stated
Irrigation Boom — a«,gn-in Date
peciallnspection 15.0
inal Date �+
Investigative Fee d'! f
THIS INSTALLATION MAY BE ORDERED DISCO ECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validation date printed in this box.
379-804� � •
IS�P�Jr��� JOB NUMBER �970600
PLEASE PRINT OR TYPE
Request Dar� � 19 �,38 Rough-in inspection required? ❑ Yes ❑ NaK Inspection Other Than Rough-In: ❑ I�ady Now ❑ Will Call
(You must catl the inspector when ready) Date Ready:
I, ❑}I�censed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
06619 CHANNEL RD NE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
ANOKA
Occupant phone No.
STANLEY J BERAUIST 571-3232
Power Supplier Address
NSP nPLS OF'F'ICE
Electrical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Only)
HASTER ELECTRIC CO.,INC. CA01192
Mailing Address (Contractor or Owner Performing Installation)
V S. SAY GE MN. 55378
Authorized Sign ture Contractor or Owner Performing Installation) Phone No.
264�.�
EB-00001A-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY