P - 81363.� -����III (I IIIII IIII I IIII IIII I(I REQUEST FOR ELECTRICAL INSPECTION �,n��,�,
Minnesota State Board of Electricity � �,.
1821 Universtty Ave., Rm. 5128, St Paul, MN 55104 �
* 0 3 9 2 4 0 1 6* Pnone �siz� saz-oaoo �`-!��'
Home �uplex Apt Bldg. Other: New Addn
id. Htg. Equip. Water Hir. 1S Load Mgmt. Other
Range Elec. Heat Temp. Service
the work covered by this requesL Enter remarks in this space and ar the 6ack ot the whife copy
SAVER'S SWITCH INSTALLATIQN
u/ate Inspection Fee - This Inspection Request will not be accep[ed withoUt the covect /ee:
Other Fee � Service Entrance Size Fee +s 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
TransformeNGenerator INSPECTOR'Sl15EONLV TOTAL �
3. Xfmr.
Control
Swi
Sc�
` Final Oz? q
Investigative Fee � —�3 —(
THIS INSTALLATION MAV BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLV This repues� voitl 18 s fmm valitlatlon date pnnleA in this bav.
392-40 �] � t�� S �
SOB NUMBEk #9�060mm
PLEASE PRINT OR TYPE
Reque�t Qa�e30 ��38 Rou9h-'m Inspec�ion requiretl? � Yes �}Qo Inspectlon OtM1er Than Rough-I¢ �{ Re dy Now p Will Call
�vou m�s� can mc inspecror wnen reeav) ozte aeaay: 11 / 30 / 98
I, �i] Ilcensed contractor ❑ owner here6y request Inspection of Ihe above electricel work at:
Job Atldress (Street Box, or Raute No-I Gity Zlp Cotle
0&PJ55 RIVERVIEW TEA NE FRIULEY 55432
Soctlon No. Tawnship Name or Na_ FL�u�9e Nn Flre Na Cuuntv
AL STAHLBERG
rawo, s��ua, naa,ess
HSP MPLS OFFICE
Eledrical Confrector (GOmpany Neme) Gornacror Gcense
C CO IHC. CA01]
Malling Pddress (COnVecror or Owner Per�orming Insielletiarl
12967 BOONE AVE S.SAVA �,C�tN.ye�ySS37E
Au[ho(izetl SignatuYe (COn4actor or Owne� Performing Inslalia��j'( ' I (
ANOKA
Phone No
786-1355
EB-OOOOtA-11 8/95 STATE BOARD COPY - SEE INSTpUCTIONS ON BACK OF VELLOW COPV
MastarLln No. �PlantElect Orly7