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*03638640*
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. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this space and on the back of the white cqoy only.
SAVER'S SWITCH INSTALLATION
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 TOTA�S :�� ,
Sign/Outline Ltg. Xfmr. •�S� i
Alarm/Remote Control
Swimming Po I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boo Rough-In Date
Speciallnspection •
Final D
Investigative Fee —� �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
________�_.__�__.__.___.------_.________------------_______�_____.___��.�
OFFICE USE ONLY This request void 18 months from validation date printed in this box.
363-864 � �
/.�, so �c'�3� �
JOB NUMBER �9706000
PLEASE PRINT OR TYPE
Request aj� � Rough-in inspection required? ❑ Yes o Inspection Other Than Rough-In: Ready Now ❑ Will Call
(You must call the inspector when ready) Date Ready: 7� 1? � 97
I, u licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) Cit Zip Code
00631 58TH AVE NE F�?IDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
ANOKA
Occupant Phone No.
JAl�ES A LEAON 571-6573
( PoNSPPlier Address
MPLS OFFICE
Electrical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Only)
I MASTER ELE�TRIC CO.,INC. CA01192
I Mailing Address (Contractor or Owner Performing Installation)
12467 800NE AVE S.SAVAGE MN. 55378
Authorize nature ( ntractor r ner Performing Installation) Phone No.
� � 941 4712/890-3555
, . ,
I EB-00001A-11 '8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BI�CK OF YELLOW COPY