P - 83067tlll�lllll IIIII IIIII IIIII IIIII IIII) IIIII IIII IIII
*03869377*
REQUEST 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. Bidg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Cond. Htg. Equip. Water Htr. oad 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 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 15.�0
Sign/Outiine Ltg. Xfmr.
Alarm/Remo t I
SwifTlfTllflg POO � I hereby certify that I inspected the electrical installation described herein on the dates stated
rigation Boom ough-In Date
peciallnspection '
Final D� �
Investigative Fee
THIS INSTALLATION MAY BE ORDERED DISCO ECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 mor�ths from validation date printed in this box.
386-937 � �� � �
JOB HUMBER �970600
PLEASE T O PE
Request Dat Rough-in inspection required? ❑ Yes ❑ No Inspection Other Than Rough-In: ❑ eady Now � Will Call
(YOU must call the inspector when ready) Date Ready: 8/ 14 % 98
I, ❑ licensed contractor ❑ owner hereby request inspection of the above electrical work at:
''°b "�i9�ii�t. B°", °` R�,`9#�I�iTOH ST NE c't"FR I DLEY Z'P °oS5432
Section No. Township Name or No. Range No. Fire No. ��� ANOKA
Occupant Phone No.
KARIE HELEN GABLE '783-8454
Power Supplier Address
NSP MPLS OF'FICE
Electrical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Ony)
liASTER ELECTRIC CO. , INC. CA0i192
Mailing Address (Contractor or Owner Performing Installation)
12467 BOONE AVE S.SAVAGE MH. 55376
Authorized Signature ( ntractor or Owner Performing Installation) PFane No.
� 94 —4712/890-355
EB-00001A-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY