P - 83012-� I Ililll IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIII IIII
*03798196*
REQUEST FOR ELECTRICAL INSPECTION �,���
Minnesota State Board of Electricity � �'
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800 ��`'�'�
Home Duplex Apt. Bidg. Other: New Addn
Commercial Industrial Farm 's � 'S � Remod Repair
Air Cond. Htg. Equip. Water Htr. oad 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 whiie copy only.
SAVER'S SWITCH INSTALLATIOH
Calculate Inspection Fee - This Inspection Request will not be accepfed 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 1,rJ. �e.
Sign/Outline Ltg. Xfmr.
Alarm/Remote ol
SWIfTlfillfl9 POOI � I hereby certify that I inspected the electrical installation described herein on the dates stated
rigation Boom ouyn-m Date
Special Inspection
Final �a�g
Investigative Fee J "' �'
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.
379-819� `�� �
,��53�� JOB NUMBER #�970600
PLEASE R T O TYPE
Request Da Rough-in inspection required? ❑ Yes ❑ N Inspection Other Than Rough-In: ❑ ady Now ❑ wll Call
(You must call the inspector when ready) Date Ready: 6/ 19 / 98
I, ❑ licensed contractor ❑ owner hereby request inspection of the above eiectrical work at:
,�ob A��s���t, Box, or R�t�.� A V E NE c't''F'R I DLEY Z'P °0�5432
Section No. Township Name or No. Range No. Fire No. County pNOKA
°o°"�°SI'ANLEY C DAEI�LBERG PhoneNo. S%1-8%GS
�o�rN�p�� /wd�ss 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)
12467 BOOHE AVE S. SAVAGE KH. 553?8
Authorized Si a rg�(Contractor or Owner Performing Installation) . ^ O� Phone No.
(/� �f 94 —4?12/890-355
EB-00001A-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY