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RE(�UEST FOR ELECTRICAL INSPECTION ���
Minnesota State Board of Electricity � °i
1821 University Ave., Rm. S-128, St. Paul, MN 55104 ,,,�
Phone (612) 642-0800 �"�"-"
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Cond. Htg. Equip. Water Htr. oad Mgmt. Other:
Dryer Range Elec. Heat emp. Service
"X" above the work covered by this request. Enter remarks in ihis 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 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 TOTAL
SignlOutline Ltg. Xfmr. 15.�0
Alarm/Remote Control
Swimmin Pool '
9 �� I hereby certify that I inspected the electrical installation described herein on the dates stated
Iffl9atlOfl BOOfII � Rough-In Date
peciallnspection 15.0 ��� p--
Investigative Fee "—� �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request vad 18 months from validation date printed in this box.
380-868�] � !� �
3�/�
JOB NUMBER �970600
PLEASE PRINT OR TYPE
Request Da� � 14 � 98 Rough-in inspection required? ❑ Yes ❑ Nov Inspection Other Than Rough-In: ❑ Ready Now ❑ Will Call
n n
(You must call the inspector when ready) Date Ready:
1, ❑�ficensed contractor ❑ owner hereby request inspection ot the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
00475 63RD AVE NE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
ANOKA
Occupan[ Phone No.
JOHN B BOGUCKI 572-9554
Power Supplier Address
NSP MPLS OF'FICE
Electrical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Only)
MASTER ELECTRIC CO.,INC. CA01192
Mailing Address (Coniractor or Owner Performing Installation)
1�467 BOONE AVE S. SAVAGE ltN. 55378
Authaized Signature (Contractor or Owner Performing Installation) Phone No.
EB-00001A-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY