P - 82838, °I�I��IIIIIIIIIIIIIII�IIIIIIIIIIIIIIIIIIIflllllll
*03799186*
REQUEST FOR ELECTRICAL INSPECTION ��
Minnesota State Board of Electricity � �
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800 �'"�°"�
Home Duplex Apt. Bidg. Other: �ry New Addn
Commercial Industrial Farm � v �� Remod Repair
Air Cond. Htg. Equip. Water Htr. oad Mgmt. Other:
Dryer Range Elec. Heat emp. Service
"X" above the work covered by this request. Enter remarks in this space and on the back ot the white copy only.
SAVER'S SWITCH INSTALLATIOAI
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 ONIY TOTAL j`O
Sign/Outline Ltg. Xfmr. 15.�"
Alarm/Remot o tr I
Swimming Po I hereby certiy that I inspected the elecirical installation described herein on the dates stated
Irrigation Boom Rough-In Date
pecial Inspection 5• 0 ;nai g.
Investigative Fee � /
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 rtan[hs from validation date printed in this box.
379-918�]
�!-� �53��
15,�XJ �JOB HUMBER �9706�0
PLEASE PRINT OR TYPE
Request Da� � i9 � 98 Rough-in inspection required? ❑ Yes ❑ Nox Inspection Other Than Rough-In: ❑ f�ady Now ❑ Will Call
(You must call the inspector when ready) Date Ready:
I, ❑N'jcensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
07574 4TH ST NE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
ANOKA
Occupant Phone No.
F' WAKS 784-7083
Power Supplier Address
NSP ![Pi.S OFF'ICE
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)
AutMrized Sign ture Contractor or Owner Performing Installation) Phone No.
EB-00001A-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY �