P - 83470.- Ii'�1111IIIIIIIIIIINIIIIIIIIIIIIIIIIIlIIIIIIIIIIII
*03789054*
REQUEST FOR ELECTRICAL INSPECTION ,��
Minnesota State Board of Electricity �`
�,, o,,.,. , _
1821 University Ave., Rm. S-128, St. Paul, MN 55104 �
Phone (612) 642-0800 ��'�
Home Duplex Apt. Bldg. Other: New Addn �I
Commercial Industriai Farm Remod Repair I
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Ente� remarks in this space and on the back of the white copy only.
SAVER'S SWITCH INSTALLATION I
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 ONLV TOTAL � 5�
Sign/Outline Ltg. Xfmr.
l�
Alarm/Remat ol
Swimming I I hereby certify that I inspected the electrical installation described herein on the datee s�ted
Irrigation Boom Rough-In oa�e
Special Inspection
Final
Investigative Fee % �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN t8 MONTHS.
OFFICE USE ONLY This request void 18 months from validation date printed in this box.
378-905� � �5-�
yi��
JOB NUMBER #9706000
PLEASE PRINT OR TYPE
Reques��fe � Rough-in inspection required? ❑ Yes o Inspection Other Than Rough-In: Ready Now ❑ Will Call
(You must call the inspector when ready) Date Ready: (�j I 1 G I 98
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
06730 4TH ST NE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
ANOKA
Occupant Phone No.
DEAN E OLSON 571-1647
Power Supplier Address
NSP MPLS OF'FICE
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 !'�M. 55378
thorized Signature (Contractor or Owner Performing Installa[ion) Phone No.
EB-OOOOtA-1 S/95 STATE BOARD COPY - SE . BACK OF YELLOW COPY