P - 81360II� II II III II III I I� I II) II I'I REQUEST FOR ELECTRICAL INSPECTION �.a"���,�
Minnesota State Board of Electricity '*� .
� 1821 University Ave., Rm. S-128, SL Paul, MN 55104 � �,.�
* 0 3 9 2 3 8 0 2* Phone fsi21 saz-oaoo ��°��-"
Home Duplex Apt Bldg. Other: New Addn
Commercial Indushial Farm Remod Repair
\ir Cond. Htg. Equip. Water Htr. g Load Mgmt Othec
)ryer Range Elec. Heat emp. Service
above Ihe wak coveied by this request. Entea iemaiks in thu space arrd w the back o/ the white copy only.
SAVER'S SWITCH INSTALLATION
ulate Inspection Fee - 7his InspeC[iat Request will not be accepted withouf the correct /ee:
Other Fee +� Servire Entrance Size Fee +� Circuits/Feetlers 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 MSPECTOfl'S USE ONLY TOTAL ,
SignlOutline Ltg. Xfmr.
Alarm/Remote Control
��
inat I inspected the eleohical lnstellalion descnbed hereln on �he Ca[es stated
Date
_'___..._�___" � Finai / ` L._ _ oai�7
Investigative Fee `� L -J �-�9'
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This reduest vdd 18 months hom valitlation tlate pn�tetl In \hls bcx.
392-380� � fs �
/�6
JOB NUMBER ri9�06000
PLEASE PRINT OR TVPE
pe4�� 4a�j 3Qj � gg qou9h-In InsPec�lon requireA? 0 Yes ��o Inspectlon Other Tha� Rou9h-In'. [x Raady Now Q Will Call
�vou must call the inspector when reatly) Dete Reatly: 11 /.�im: �R
I. � Ilcensed contractor ❑ owner here6y request inspectlon of the above electrical work at
,bb Atldress (Street, Box, or Roule NoJ G[y ➢p Cotle
00419 RICE CREEK TER NE FRFDLEY 55432
Sec[bn No. Township Name ar No- Winge Na F4e No. GaunO�
Omupant
ANDKA
PM1One No.
HSP MPL9 OFFIGE
Elechical Contractor (Gvmpany Name) Contraclor Liconse No. Mester Lia No. (Plen� EIecL Only)
HASTER ELECTRIC CO.,INC. L"A01192
Malling Address (Gon[racror or Owner Pertorming Installa�ion)
EB-00001A-11 8/95 STATE BOAHO COPV - SEE INSTRUCTIONS ON 6ACK OF VELLOW COPV