P - 83728i I, I REQUEST FOR ELECTRICAL INSPECTION ��,
," I I�II�I IIIII IIIII IIIII IIIII IIIII IIIII IIIII III� IIII 1^g2leUni eSs ty A earRmf Sle 28cSt. Paul MN 55104 �_ �:
* 0 3 6 3 2 5 7 7* Phone (612) 642-0800 � ����:�
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request Enter remarks in this space and on the back of the white cqoy only.
SAVER'S SWITCH IHSTALLATION
Calculate lnspection Fee - This Inspeciion Requesi will not be accepted without ihe 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 e
Sign/Outline Ltg. Xfmr. lr'Jr�
Alarm/Remote Control
Swimming Pool I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In Date
Special Inspecti
Final �te � �7�/
Investigative Fe � ( a
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS_
OFFICE USE ONLY This request void 1S months from validation date printed in this box.
363-257�] �3 � �
/5 ��
JOH NUMBER #t9706000
PLEASE PRINT OR TYPE
Request a� � Rough-in inspection required? ❑ Yes o Inspection Other Than Rough-In: Ready Now ❑ Will Call
(You must call the inspector when ready) Date Ready: '� � 1'� � fj"l
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
04875 2 1/2 ST HE FRIDLEY 55421
Section No. Township Name or No. Range No. Fire No. County
ANOKA
Occupant Phone No.
SCOTT BULTENA 502-0654
Power Supplier Address
NSP MPLS OFFICE
Electrical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Only)
MASTER ELECTRIC CO. INC. CA01192
Mailing Address (Contractor or Owner Performing Installation)
12467 BOONE AVE S. SAVAGE liN. 55378
� Auth � ed Signa r(Contra r wner Performing I tallation) Phone No.
25����
, � -
I EB-00001A-11� 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OP YELLOW COPY