P - 83473' I��IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII REQUEST FOR ELECTRICAL INSPECTION -
Minnesota State Board of Electricdy �� �.
1821 University Ave., Rm. S-12$ St. Paul, MN 55104 �. _
` * 0 3 7 8 8 8 6 6� 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 emp. 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 lnspection 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 TOTAI
Sign/Outline Ltg. Xfmr. 15. S0
Alarm/Remote Control
Swimming Pool I hereby certify that I inspected the electrical installation described herein on the dates stated
Ifl'1g81'I � Rough-In Date
X Special Inspec ion
Investigative Fee Final p t�_ ��
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITy"'`"""`""�—" -
� OFFICE USE ONLY This request void 18 months from validation date printed in this box.
378-886;�] �s�
��3y
JOH NUMBER �t9706000
PLEASE PRINT OR TYPE
Reques��16 � gg Rough-in inspection required? ❑ Yes �lo Inspection Other Than Rough-In: � Ready Now ❑ Will Call
(You must call the inspector when ready) oate Ready: �j I 1(�/ 9$
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
01591 60TH AVE NE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
ANOKA
Occupant �Phone No.
CRAIG E EL.SE 574-0686
Power Supplier Address
NSP MPGS 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 BOONE AVE S. SAVAGE MN. 55378
Aut iz Sig ture (Contractor or Owner Performing Installatjqp) ^ .. Phone No.
�.iJ 941 4712/890-3555
�
� EB-OOOOtA-11 /95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY