P - 81399I�li1IIIIIlIIIIIlIIIII IIII IIIIIIIIIIII II REQUEST FOR ELECTRICAL INSPECTION ��
Minnesota State Board of Elechicity ���_.
1821 University Ave., Rm. 5-128, St. Paul, MN 55104 � �
* 0 3 9 2 3 6 9 5* Pnone�sizJsaz-oeoo '��� `
Home Duplex Apt. Bldq. Other: New Addn
abwe the wwk
�.quip. Water Hh. -- Loatl Mgmt Other:
Elec. Heat Temp. Service
by this request Enter remarks in this space and on the back o1 the white copy
SAVEk'S SWITCH INSTALLATION
Calculafe In�ection Fee - This In;oectirn Reques[ wi!! not be accep[ed without the correct /ee:
Olher 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
Tfansformer/Generator insrecroa'S use oN�v TOTALI�' J�
Sign/Outline Ltg. Xfmr. j
Alarm/Remot
Swifllming PO I nerecy certity fiet � Inspec�etl �ne eiechioai Ins�al�ation aesoribetl �ereln on ihe datES statetl
,. IrrigationBoom . __ Rown-m oa�e
Final
Investigative Fee �
THIS INSTALLATION MAY BE
392-36�5]
DISCONNECTED IF NOT COMPLETED WI71iIN 18 MONTHS.
OFFICE USE ONLY This reqi.est wid 18 moMhs irom valltlation tlate priMetl In ihis �ox.
�/a6's,�
JGB NUMBEk Ji9�0L,OJfd�i
PLEASE PRINT OR TYPE
Re4 RougMn Inspec�ion requiraf? �`/es ❑ Inspedlon OMer Than Rou9h-In_ Ready Now � Will Call
IVOU mus� cell the lospeclor when reatly) �ato Reetly 11 �.j0 ���
I, licensed contractor ❑ owner hereby request lnspection oF Ihe a6ove electrical work at
'°���$��fee1BOxor�'P�`e"P%2 WAY NE ��I?IDLEY ZP��43<
Seotion No. Townshlp Name or No. Range Na Fre No_ Counry ANOK A
oc�.VIN KOCINSKI Phone� 571-2994
Powar Supplior Address
NSP MPLS OFFICE
Eleclrical Conirsctor (Company Name) Con�rac�or Gcense No.
MAbTER E.LECTRIC CO.,INL. CA01192
AAallirg Atltlress (ConVactor or Owncr Performing Inslallation)
12467 BOOHE AVE �.SAVAGE MN. 55378
Mast2r lia_ Np.
AWhorrzaa SgnaNre �COntrdc[or or Owner Perbrming Inatalletlgp) Phone No.
V " `
.,�i��.� � 941 4712/$90-3555
B-OOOOlA-11 8.�95 STATE BOARD COPV - SEE INSTqUCTIONS ON BACK OF YELLOW COPV