P - 81372lIN IiI II I I I II II IIII I II II III III REQUEST FOR ELEC,�ICAL INSPECTION ����
Minnesota State Board of Elechici}y
1821 University Ave., Rm. 5-128, St. PaW, MN 55104 � �'
� * 0 3 9 2 4 1 8 0't Phone (612) 642-0800 �`_�•>
Home Duplex Apt 81dg. Other: New Addn
Water Htc H Loatl Mgmt Other.
Elec. Heat emp. Service
request Enter �emarks in this space and on the back oi the white copy only.
SAVER'S SWITCH TNSTALLATION
In§uec[ion Fee - 7his InspecGOn Request will not be xcepted without the cwrec[ tee:
Other Fee a Service Entrance Size Fee � Circuits/Feetlers Fee
le Home Park Stall 0 to 200 Amps 0 to 100 Amps
�t Ltg./Traffic Sig. Above 200_Amps Above 100_Amps
;formeNGenerator INSPECTOR'S USE ONLY TOTA�� S�
/Outline Lta. Xfmr.
in iy r�v� I hereby csrfily ihat I inspec[etl the eleohical installation desaibed he�ein on �he dates sta�etl
Ilflg2[iOn BOO �% Rough-In Date
}� Special lnspection I. Sfl F, ai �+
Investigative Fee �r----�^-- —2 - / 9
�THIS INSTALLATION MAY BE ORDERED DIS ECTED IF NOT COMPLEIED WITHIN 18 MONTHS.
OFFICE USE ONLV This repuest voitl 18 months fmm validaMOn tlate pnnted in �his box.
392-41 �] � �S. �
/`d 6
JOB NUMBER k�06000
PLEASE PRINT OR TYPE
ReQOi� ii 30 / 9t3 aa,en-�� ��,�oa�rb�,ea�aeaa p u� p�o msaaam� on, ma� a�,en-m: � aeaav Now p wn c�i
(Vou must cail iM1O Inepector when reatlyl �ete Reatly:
I, �f licensed contraotor ❑ owner hereby request inspection of the a6ove electrical work at
Job Address IS[reeL 9ox, or RoNe Na.) Clry Zip Cotle
06291 VAN BUREN ST NE FRIDLEY 55432
Seclion No. Township Name or No. Range No. Fire Nn County
ANOKA
Ocwpanl PM1,�ne No.
DANIEL B Yl7UNGMARK 571-2728
Power Supplier htldrese
NSP MPLS OFFLCE
Electtical Con�aclor (Company Name) Conhactor Llcerise Na- Mester Ge_ No. (%en� Elecl
ltASTER ELECTRIC C0. , INt;. CA01192
Melling Addrass (Gontrec�or or Ownsr Periwming InsWlla�ion)
12467 BOONE AVE S.SAVAGE MN. 55378
Authonzetl Signature (GOn tor orOwner Portorminglnstalla��� ^ q Phone No_
V ij
E6-p00p1A-i t 8/95 STATE BOARD COPV - SEE INSTRUCTIONS ON BACK OF VELLOW COPV