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Minnesota State Board of Electricity �
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* 0 3 9 2 3 4 8 9* 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 emp. 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 INSTALLATIOhI
Calculate Inspection Fee - This Inspection Request will not be accepted without the carect 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
Sign/Outline Ltg. Xfmr. �� 50
Alarm/Rem I
SWIfTII'Tllfl9 P� I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In Date
Speciallnspection •
Final ate
Investigative Fee — 2/—' �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 1S months from validation date printed in this box.
392-348 � ,S �
/�
JOB HUMBER �9$@6000
PLEASE PRINT OR TYPE
Reque� Qay6 30 I[�� Rough-in inspection required? ❑ Yes ❑�o Inspection Other Than Rough-In: �{ Ready Now ❑ Will Call
(You mus[ call the inspector when ready) Date Ready: 1,�, I 3@ I 98
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) Ciry Zip Code
00129 HORI20N CIR NE FAIDLEY 55421
Section No. Township Name or No. Range No. Fire No. County
AHOKA
Occupant Phone No.
JOSEPH DZUBAK 572-1013
Power Supplier Address
HSP MPLS OFFICE
Electrical Contractor (Comparry Name) Contractor License No. Master Lic. No. (Plant Elect. Ony)
HASTER ELECTRIC CO. , IHC. CA011'32
Mailirg Address (Contractor or Owner Performing Installation)
12467 BOONE AVE S. SAVAGE MN. 55378
Authorized Signature (Contractor or Owner Performi� ) Phone No.
�� � 941 4?12/890-3555
EB-00001A-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY