P - 84110IIIIII �III IIIII IIIII IIIII IIIII IIIII IIIII III) IIII
*0371661Q*
REQUEST FOR ELECTRICAL INSPECTION ��,
Minnesota State Board of Electricity �� `"
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800 �"-� "6
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other: II
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. I
SAVER'S SWITCH INSTALLATIOAI
I
Calculate In�oection Fee - This Inspection Request will not be accepted wifhout the conect 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. J0
Sign/Outline Ltg. Xfmr.
Alarm/Remot cxrtr�aal
Swimming Po � I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In Date
Special Inspection
Final t ^ %
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.
371-661 [� �5, �
�-{��L�"9 �� JOB HUMBER #9706000
PLE TYPE
Requ t te Rough-in inspection required? ❑ Yes o Inspection Other Than Rough-In: Ready Now 4 Will Call
(You must call the inspector when ready) Date Ready: 10 � 17 / 97
I, ❑ licensed contractor ❑ owner hereby request inspection of the above electrical work at:
��e���treet,Box,�R��iPo.) AVE HE �''FtIDLEY Z''��l32
� � ��
Section No. Township Name or No. Range No. Fire No. County ANOKA
°`�'�"�'ER A LESCHISIN PhoneNo. 5,72'900,7
Po�err,JS�plier AddressMPLS OFFICE
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)
12467 BOOHE AVE S. SAVAGE C[N. 55378
Auth � 'g ture (Contractor or Owner Performing Installation) Phone No.
� �' r` , ;" 941 47121890-3555
� �
� EB-00001 11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY