P - 81398�`I_I I I REQUEST FOR ELECTRICAL WSPECTION �
�!`�III �II�II IIIII�IIIIIII IIIIII� II III Minnesota State Board of Electricity � ��
,�� � � 1821 University Ave, Rm. 5-128, St. Pau�, MN 55104 �
* 0 3 9 2 4 0 3 2 * Phone (612) 642-0800 ����-
Home �uplex Apt. Bldg. Other New Addn
ip. vva[er Htr. -- �oad rvigmt. OMer
Elec. Heat emp. Service
fhis �equest EMer rema�ks in fhis space and on the Lack of fhe white copy
SAVER'S SWITCH INSTALLATION
ulate lnspection Fee - 7his Inspection Request will rrof be accEpted withouf the conect lee'
Other Fee = Service Entrance Size Fee n Circuits/Feeders Fee
Mobile Home Park Stall � � � O to 200 Amps � ��0 fo 100 Amps �
Street LtgJTraffic Sig. A6ove 200 Amps A6ove 100_ _Amps
Transformer/Generator INSPECTOR'S USE ONLV TOTAL /'
Xfmr.
S@
—""""""�' ' "� I M1ereby cerli�y ihat I inspec[etl tbe elechical inrtalla�ioo desaibatl hareln on Me tlates sla(etl
Irrigation Boom � ao�5n-m oaie
Special Inspection • J
Investigative Fee Finai - p����ay. ��
_ THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY TM1is request void 1B months hom valitlation date. Frintetl ic Mis box.
92-40�] ------ �5.�
�026
JOB NUMBER �i9Q0600�t�
PLEASE PRINT OR TYPE
�� Fou�h-in-mspec[ior requireC? � Yes o Inspedion O1M1er Than RougMln'. Aeatly Now � Will Call
IVOU muet oell Ihe inspecwr when reatly) Date Reatly ]..L % 3Q� � r-J�{
, licensed contractor ❑ owner here6y request inspection of the above electrical work at:
dot��a�s��s�o-eatsox,o��'�� PL NE �?IDLEY Zo�`,�e4'�2
Section No. Township Name or No. Range No. Fire No. Counry
ANOKA
Oacupant Phone ho.
WILLIAM L TALLEY 574-1'352
Po�i2r Supplier Pda�ess
HSP MPLS OFFICE
Electrbal Con[ractor (COmpany Nrunel Gontraomr License No. Master Llo. No-�P�ant Elec[ Only)
MASTER ELECTRIG CO.,IMC. CA�D1I92
Malling qtltlress (ConVecror or Owner Petlorming Installationj
12467 S�QNE AVE S.SAVAGE PiM. 55378
Au[honzetl Slgnaturs (Canirector or Owrier Pedorminq Iristallatlar) PMona un
EB-00001A-11 8i95 STATE BOARO COPV - SEE WSTRIlCT10N5 ON BAL'f( OF VELLOW COPV