P - 83693�
'' I��IIIII�IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII R82�1 UEiSersFORve.LRm. SRiC8, St PaPEMNION04 ���� �
Minnesota State Board of Electricity �
* 0 3 6 3 3 5 1 8* Phone (612) 642-0800 �`_��� �
Home Duplex Apt. B�dg. Other: New Addn I
Commercial Industrial Farm Remod Repair I
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 ot the white copy only. �
SAVER'S SWITCH INSTALLATIOH �I
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct tee: I
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee I
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Amps Above 100 Amps II
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 on the dates stated
Irrigation Boom Rough-In Date
ISpeciallnspect�
I Investigative Fe � Final �" o�g � ��
J
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validation date printed in this box.
363-351 �
��ga�
�5r5� JOB HUI7BER �9706000
PLEA T TYPE
Request e Rough-in inspection required? ❑ Yes o Inspection Other Than Rough-In: Ready Now ❑ Will Call
(You must call the inspector when ready) Date Ready 7 j 17 � 97
I, licensed contractor ❑ owner hereby request inspection of the above electrical work at:
�o��r�reet, Box, c���E ST NE �`�4IDLEY Z"�'�l32
Section No. Township Name or No. Range No. Fire No. County ANOKA
°`�i`�VEN ALLEN KROGER PhoneNO. C��-0296
J
Pqy�,$�pplier Address
���°�r KPLS OFPICE
E��rtA��ont��ra�ctor �Co�m.�anYTR I C C0. � I NC. contrCtA01192 Master Lic. No. (Plant Elect. Only)
T Fr t:t:
Mailing Address (Contractor or Owner Performing Installation)
12467 BOONE AVE S. SAVAGE IiN. 55378
Author ed ignature Contract r or wner Performing Ins�tiplT) ^�� Phone Na �
"� 941— 712/8 —
EB-00001A-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY j