P - 82855,� i il�l� ����� (���� ����� ����� ����� ����� ����� ���� ����
*03798576*
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: New Addn
Commercial Industrial Farm SQ �� 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 of the white copy only.
SAVER'S SWITCH IHSTALLATION
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 ONLY TOTAL �
Sign/Outline Ltg. Xfmr. 1S.$�'
Alarm/Remote Control
Swimming P C� I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Bo Rough-In Date
peciallnspection •
Final n�r° � N �
Investigative Fee L /
THIS INSTALLATION MAY BE ORDERED DISCO _ ECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 rtanths from validation date printed in this box.
379-$57�] � �
'�' ����9 JOH itUMBER #970600
PLEASE PRINT OR TYPE
Request Da Rough-in inspection required? ❑ Yes ❑ N Inspection Other Than Rough-In: ❑ dy Now � wll Call
(YOU must call the inspector when ready) Date Ready. 6/ 19 / 98
I, ❑ icensed contractor ❑ owner hereby request inspection of the above electrical work at:
,�ob /�`�4'�t' soX, or R�'t��I PL AlE c�t'I�"R I DLEY Z�p �5432
Section No. Township Name or No. Range No. Fire No. County
AN�KA
Occupant Phone No.
SANDRA M JOSWIAK 572-1979
,
Power Supplier Address
NSF MPLS OFFIGE
Electricai 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 MM. 55378
Authorized Signatur ( ntractor or Owner Performing Installation 6 3 9 � Phone No.
94 —47 2/890-3 5
EB-00001A-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY