P - 81357,.'I�III��IIIIIII�IIIIII��I�IIII��IIIIIIIIIIII M$ n�Uotla �tatOeB ardRm.SR1P8,cStPaPEMNION04 ������
* 0 3 9 2 3 9 7 6* Pno�e (siz� saz-oaoo '�+�
Home Duplex Apt. Bldg. Other: New Addn
trial Farm F
!quip. Water Htr. Load Mgmt Other:
e Elec. Heat emp. Service
by [his request. EMer remaiks in this space and on the back o/ the whi[e copy
SAVER'S SWITCH INSTALLATION
lnspection Fee - 7his Ins,oection Request will not be accepled without the correct fee:
Other Fee � SerVice EnUance Sire Fee +� Circuits/Feeders Fee
le Home Park Stall 0 to 200 Amps 0 to 100 Amps
�t LtgJTreffic Sig. Above 200 Amps Above 100 Amps
�formeNGenerator INSPECTOR'SUSEONLY TOTA `
/Outline Lta. Xfmr. �9. 50
°�y I hereby oehlfy thet I inspec[etl the elaotncal lnstallatlon des[.vlbetl Y�erein on ihe tlatss s�eteA
�1"fl(]2i10l1 800f11 � � Rou�h-In Date
Special Inspection
Investigative Fee F��:i� CL-2 --m._---- � oa��zj-2� �
` THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLV This request wid 18 rtanihs irom valitla[ion tla�e prin�eC in ihis box.
392-397�6 . /d�5,�
JOB NUMBER #9$06�d��D
PLEASE PRINT OR TVPE ,�!
RaqUe�t �a� � Roug�-In Inspection �epulretl? 0 Yes ❑ o I�ppec[ion Otha� Then Ro�gn-Irt y� Reetly Now � VNII Call
�,r., ivo� m�s� �an ene ��sPe�m� wne� reaav> �aie aeaM_ 11 / 30 / 9 E',
1, fJ licensed contrautor ❑ owr�er here6y request inspecti�n of the above electrical work at:
Job Atltlress (9Vee1, Box, or Roete No.� GRy Zip Cotle
P16610 F'IERCE ST NE FRIULEY 5543'�'.
Sec�ion No. Township Name or No. Ran3e Nn Fire No. Gounty
ANOKA
HURTON H SI;HERVEN
Pov✓er Supplier AdCress
NSP tiFLS OFFTCE
Elaqrioel Conhactor (GOmpany Neme) GonVactor Ltcense No.
CfA3TER ELECTRIC CD.,INC. GA01I92
Mailing Adtlress (COnirnctor or Owner Per(orming Ir�stallation)
12467 BOOHE AVE S.SAVAGE MH. 55378
AoMorizetl Slgnat�re (GorutacfQr orOVnie-Pertortninglnsfallatiu�i�
EB-00001A-11 8/95 STATE BOARO COPV - SEE INSTRUCTIONS ON BqCK OF VELLOW COPY
5'71-4480
Master Go. No-IPIantElect Onl9)
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