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*0379$451*
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. Bldg. Other: /j New Addn
Commercial Industrial Farm ��/ � C Remod Repair
Air Cond. Htg. Equip. Water Htr. oad Mgmt. Other:
Dryer Range Elec. Heat emp. Service
"X" above the work covered by ihis 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 �"Q
Sign/Outiine Ltg. Xfmr. 15. @�'
Alarm/Remote Control
SWIRIlTllfl9 POO�. . I hereby certify that I inspectetl the electrical installation described herein on the da[es sta[ed
il'1'Ig8t1011 BOOfTI� � Rough-In Date
ecial inspection s� 0�n� o ��
Investigative Fee
_ THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request wid 18 months from validation date priMed in this box.
379-845�1 S� •
l� � � � /q
JOB HUMBER �l970600
PLEASE PRINT OR TYPE
Request Da� / 19 r 98 Raigh-in inspection required? ❑ Yes ❑ Nc� Inspection Other 7han Rough-In: ❑ Aeady Now � Will Call
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(You must call the inspector when ready) Date Ready:
I, ❑jjjcensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
06420 STARLITE CIR NE FRIDLEY 55432
Sedion No. Township Name or No. Range No. Fire No. County
ANOKA
Occupant PFwne No.
F'ONDA JO HAVLIK 5'72-2316
Power Supplier Address
NSP MPLS OFPICE
Electrical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Only)
Mailing P�ress (Contractor or Owner Performing Installation)
Authorized ' natur Contractor or Owner Performing Installation) Phone No.
EB-00001A-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY