P - 84111I�I�IEIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII R8 Q UESe SFORve.LRm. SR1C8, StN aPEMNION04 �����'
Minnesota State Board of Electricity '�
'* 0 3 7 1 6 5 4 5* 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 Temp. Service
X" above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
SAVER'S SWITCH IHSTALLATION
�alculate Ins,nection 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 TOTLIL
Sign/Outline Ltg. Xfmr. 15. 50
Alarm/Remote ontr I
Swimming Po I hereby certify that I inspected the electricai installation described herein on the dates stated
Irrigation Boom Rougn-in Date
Special inspection •
Final Date/ � �-�^�
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.
371-654 [� � �, �
�` ���`�/ JOB NUMBER #9706000
PLEASE PRINT OR TYPE
Requ�t(�a�21'7 � 9'� Rough-in inspection required? ❑ Yes �{Jo Inspection Other Than Rough-In: [� Ready Now ❑ Will Call
(You must call the inspector when ready) Date Ready: ,i, 0I 1% I 9%
I, }J licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
0Q1596 63RD AVE HE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County I
ANOKA
Occupant Phone No.
KEYIN B JOHNSON 574-2019
Power Supplier Address I
NSP MPLS OF'FICE
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)
Aut S' ature (Contractor or Owner Performing Installation) Phone No.
:. e �
/� �! (.
=B-00 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY