P - 84104III��IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII R8 QUESe SFORve.LRm. SR1C8, StN aPEMNION04 �����
Minnesota State Board of Electricity �
* n� 7 y � 7 r� n* 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 copy only.
SAVER'S SWITCH INSTALLATION
Calculate Inspection Fee - This Inspection Request will not be accepted without the correci 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. 15. 50
Alarm/Remote qltrqF� <-� �-.
Swimming Poo �� �� I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In Date
Special Inspection
Final �
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. I
371-675
,/� ,� /��5�� �
� � 7 `� JOB NUMSER #9706000
PLEASE PRINT OR TYPE
Requ e Rough-in inspection required? ❑ Yes o Inspection Other Than Rough-In: Ready Now ❑ Will Call I
(You must call the inspector when ready) Date Ready: 10 � 1%� 9% I
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at: II
�ar�n�d���street, Box, o5T1� N��T NE Ftl� I DLEY Z�P55432 II
Section No. Township Name or No. Range No. Fire No. County
ANOKA
Occupant Phone No.
ELEANORE !i OCEL 571-5625
Power Supplier Address
NSP KPLS 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)
124b7 BOIJNE AVE S. SAVAGE HN. 55378
Author' n ure (Contractor or Owner Performing Installation) Phone No.
� �° � 7 `� 941 4712/890-3555
EB-00001A- /95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY