P - 83664I III�� IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIII IIII
' *03632585*
Home Duplex AI
REGIUEST FOR ELECTRICAL INSPECTION ����
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104 „�.��
Phone(612)642-0800
Other:
New Addn
Remod Repair
�ommercial Industrial Farm
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
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 fee: Fee
Other Fee
u Service Entrance Size Fee # Circuits/Feeders
0 to 200 Amps 0 to 100 Amps
Mobile Home Park Stall Above 100 Amps
Street Ltg./Traffic Sig. Above 200 Amps ` �
Transformer/Generator INSPECTOR'S USE ONLY
TOTA� 5 •'
Sign/Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool I hereby certify that I inspected the electrical installation described herein ° Date dates stated
Irrigation Boom Rough-In
Special Insp o te _ �
. � � � Final � _Y�`/� � �� � .
Investigative �'
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTH .�
"�� '—'�— . . OFFICE USE ONLY This request void 18 months from validation date printed in this box.
363-258 . C ..� �3��
� � �
���`� JOB NUMBER �9706000
PLEASE PRINT OR TYPE
Rough-In inspection required? ❑ Yes o Inspection Other Than Rough-In: Ready Now ❑ Will Call
Request '� � ,�, % � 9%
(You must call the inspector when ready)
Date Ready:
I, LJ licensed contractor ❑ owner hereby request inspection of the above electrical work at:
c�t Z�P55432
Job Address (Street, Box, or Route No. �,+� I D'L '�.+,'Y
@5433 E BR�NNE� rAS
Section No. Township Name or No.
Range No. Fire No. I Counry AHOKA
Phone No.
Occupant BURGAU
SHARON F
Address
PowerSupplier KpLS OFF'ICE
NSP
Electrical Contractor (Company Name)
Contractor License No.
!'[ASTER ELECTRIC CO. , INC. CA01192
Mailing Address (Contractor or Owner Performing Installation)
12467 800NE AVE S. SAVAGE ltN. 5537B
�. .. .__, �._..,.....,. �r,..,r.��r�. c�wner Performing Installation)
5?1-2449
STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY
Master Lic. No. (Plant Elect. Only)
Phone