P - 81397.IIIIIII) II I II) IIIIII III) I I(II RE�UEST FOR ELECTRICAL INSPECTION �t'�@� ,��
Minnesota State Board of Elechiaty ��$; '
♦ 1821 University Ave., Rm. 5-128, St. Paul, MN 55104 � �'
` * 0 3 9 2 3 5 3 9* Pno�e �s i z� saz-oaoo ��� -
Home Duplex Apt. Blda. Other. New Addn
Other:
requesL Entei remarks in ihis space and wr [he back of the white copy onty.
SAVEk'S SWITCH INSTALLATION
Mspeption Fee - This Inspecfion Request wi0 not be accepted withouf the correct /ee:
Other Fee > Service Entrance Size Fee � Circuits/Feeders Fee
le Home Park Stall 0 to 200 Amps 0 to 100 Amps
�t Ltg./Traffic Sig. Above 200 Amps Above 100_Amps
sformer/Generator INSPECTOR'S USE ONLY TOTA
Sign/Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pooi � �
Irrigation B��
Fee
392-35�9
k.�. 5�
;I hereby certily thal I Ineoecletl Ihe elecincal Inshallallon tlescribed herein on Ne dates staletl
Rough-In oate
��,� C��! � ���
BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLV This request wq 18 mwrtlis from valitlation tla�e pnntetl in �hls box.
�ia6s�
JOB t1UMBER #9$0E�000
PLEASE PRINT OR TYPE
Req Rou3h in Inspec�ion reaviretl? 0 Yes ❑ o Irispection Other Than Fougn-In'. Reatly Now 0 Will Call
�(, IVw mus� call [M1e inspeclor when ready) oate Ready: 1 Z/�� / 9B
I, u licensed contractor ❑ owner here6y request inspection of the above electrical work at
�or����e,�o-ee�.eo.,o�wfi�� AVE NE ��?IDLEY zip.Fi�42i
Section No. Townshi0 Name or No. Pange No. Fire No. County
ANOKA
o���Pa�� m�� No
DELDRA L FIERS S'71-2981
Ns'P
MPLS OFFICE
GonVactor Gcense No_
MASTER ELECTRIC CO.,INC. CA01192
Melling Atltlress (COntrxNr or Ownor Pedorming Ins[alla�ion)
12467 B�OHE AVE S.SAVAGE MN. 5537+3
Authonzetl Slgna�me (Confracbr or Ow�r Perbrming Iristalle�pn� �^�� �� Phone No.
�V
� 941 471�
EE-ppp01A-1 t 8/95 STATE BOARD COPY - SEE INSTHULTIONS ON BACK OF YELLOW COPY