P - 83413, I IIIIII �III IIIII IIIII IIIII IIIII IIIII IIIII �III IIII
*03789146*
REQUEST FOR ELECTRICAL INSPECTION �c��
Minnesota State Board of Electricity �� °i
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 work covered by this request. Enter remarks in this space and on the back of the white copy only.
SAVER'S SWITCH IiISTALLATION
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 ONLV TOTAL
SignlOutline Ltg. Xfmr. 15. S0
Alarm/Remote Control
Swimming Pool I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigatio 001T1 Rough-In Date
Special � '�
Final . D�1B'G, �/ � Q
Investigative Fee ( `-' /
THIS INSTALLATION MAY BE ORDERED DISCONNECTED tF NOT COMPLETED WITHIN 18 MONTHS.
------ - -___________.__________.._.,.�r.���.�...
OFFICE USE ONLY This request void 18 months from validation date printed in this box.
378-914� • �s�
y�3 y
JOB NUMBER �9706000
PLEASE PRINT OR TYPE
Reques��!'e16 � C38 Rough-in inspection required? ❑ Yes [�{lo Inspection Other Than Rough-In: � Ready Now ❑ Will Gall
(You must call the inspector when ready) Date Ready: G I S G I S8
I, v licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
05557 E OBERLIN CIR FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. Counry
ANOKA
Occupant Phone No.
DARLENE SCOTT 574-9828
Power Supplier Address
NSP MPLS OFFICE
Electrical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Only)
HASTER ELECTRIC Cl�. , INC. CA01192
Mailing Address (Contractor or Owner Performing Installation)
124fi7 BOONE AVE S. SAVAGE MN. 55378
� ed Signature (Contractor or Owner Performing Installation) Phone No.
941 4712/890-3555
EB-00001A-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY