P - 81384��� Illllllllflllll Illlfl Ill Illllil Il II REQUEST FOR ELECTRICAL INSPECTION ����
Minnesota State Board of Electricity �� ;
1821 Universiry Ave., Rm. 5-128, St. Paul, MN 55104 � �
' 0 3 9 2 3 5 1 3* Pnooe�sizJsaz-osoo --��-
tir Cond. Htg. Equip. Water Htc `* loatl Mgmt Other.
Dryer Range Elea Heat emp. Service
above the work co✓ered by fhis iequesG Enter remarks in this .;vace antl on the back ot the white copy only.
SAVER'S SWITCH INSTALLATION
Calcu(ate In�ppeciion Fee - Tliis lnspeciiwr Reques[ wi77 rrot be acccPtetl without [he correc! tee:
Other Fee � Service Entrance Size Fee � Circuits/Feeders Fee
Mobile Home Park Stall O to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200_Amps Above 100_Amps
Transformer/Generator MSPECTOfl'S USE ONLY TOTAI,��( 5m
Siqn/Outline Ltq, Xfmr. f'�
rvestigative Fee �
fHIS INSTALLATION MAV
392-351�]
I hereby certiry (hat I inspected ttie elecincel inslallation described herein on the dates sYeted
Rou9h-Ir. �a[e
Flne� /7 �o ✓�—_ oateL �6' ��
�� l_v �
ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE Ory�f Thls requert witl 18 months fmm validation dale prin�etl in this box�
� i��s�
JflB NUMHEk k9$Qs6004�
PLEASE PRINT OR TVPE
Reque Rough-In Irvspec0on reqoiretl? � Ves ❑ o InsOection Other Then Rougn�n�. Reatly Now p WIII Call
(Vw must oall Hte Inspec�or wM1On reatly) �ate Re2tly. ,�, j i� 0��i 8
I, [� licensed contracCOr ❑ owner hereby request lnspection ot the a6ove electrical work at
��0487�t�eLeox��3RD���ST NE ��F'RIDLEY ��� 5421
$ection Na Townshlp Name or No_ Ranpe Na Fire Na County
ANOKA
Occupant Phone Nc.
KAREH F ERICKS�N 7i3-3108
HSP MPLS OFFICE
Elec�ncal Conirector (Company Name) ConVector Llcense No. Master Lic. No_ (PI2rt Eleot Only�
MASTER ELECTRIC: CO.,INC. CAt�1192
Maling Atltlress (COritrector or Owrer Pedorming Installation�
12467 BDDNE AVE S.SAVAGE MN. 55378
Authorizetl Signature (Con�rzdor or Ownerc Performin9lristellatio`l�� +ap Phone No.
F+VO�� 941 4712/85
E&00001A-i 1 8-95 STATE BOAHO COPV - SEE INSTRIICTIONS ON BACK OF YELLOW COPY