P - 82853I�I�E�I�II) IIIII IIII) IIIII IIIII IIII) IIIII IIII (III
*03798667*
REQUEST FOR ELECTRICAL INSPECTION �,��
Minnesota State Board of Electricity °'
1821 University Ave., Rm. S-128, St. Paul, MN 55104 �y :
Phone (612) 642-0800 ��"���
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm �� S� Remod Repair
Air Cond. Htg. Equip. Water Htr. oad Mgmt. Other:
Dryer Range Elec. Heat emp. Service
"X" above ihe 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 20p Amps 0 to 100 Amps
Street Ltg./Tratfic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL ,,$"Q
Sign/Outline Ltg. Xfmr. 1 r'J. 8�'
Alarm/Remote Control
Swimming Pool I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In Date
pecial Inspec � n 0
inal D
Investigative F -- �Z: ^
THIS INSTALLATION MAY BE ORDERED DISCONNEC7'ED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validation date printed in this box.
379-866�] ��,� �
��`5�/9 JOB NUMHER �k970600
PLEASE PRINT OR TYPE
Request oa� � i 9� 98 Rough-in inspection required? ❑ Yes ❑ N� Inspection Other Than Rough-In: ❑�ady Now ❑ Will Call
(You must call the inspector when ready) Date Ready:
I, ❑Kcensed contractor ❑ owner hereby request inspection of the above electrical work at:
.bb Address (Street, Box, or Route No.) City Zip Code
00134 63 1/2 WAY NE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
ANOKA
Occupant Phone No.
ROSEMARY KUMHERA 574-9502
Power Supplier Address
NSP MPLS OF'FICE
Electrical Contractor (Comparry Name) Contractor License No. Master Lic. No. (Plant Elect. Only)
MASTER ELECTRIC C0. INC. CA01192
Mailing Address (Contractor or Owner Performing Installation)
Authorized i at e(Contrador or Owner Performing Installation) 2 6 3 9 3 Phone No.
EB-00001A-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY