P - 84112,'II�I�IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII R8 QU�ESe SFORve.LRm. SRIC8 StN SPEMNION04 �������,��,;
Minnesota State Board of Electricity � °i
* Q 3 7 1 6 7 6 8* 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 emp. Service
"X" above the work covered by this request. Enter remarks in this space and on the back of ihe white copy only.
SAVER'S SWITCH INSTALLATION
Calculate In�oection 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 ONLV TOTAL
Sign/Outline Ltg. Xfmr. 15. �J0
Alarm/Rem �o ol
r.
Swimming �� � I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In Date
Special Inspection
Final �]?W � �� _� X
Investigative Fee l L V
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.
371-676 [� ��� �� �
��!/'T%�� JOB NUMBER #970600Q1
PLEASE PRINT OR TYPE
Requ�T�a�21'� � g'� Rough-in inspection required? ❑ Yes �lo Inspection Other Than Rough-In: � Ready Now ❑ Will Call
(You must call the inspector when ready) Date Ready: 10I 1% I9%
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route NoJ Ciry Zip Code
01442 64TH AVE NE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
Occupant
BRUCE R
Power Supplier
OLSON
Address
ANOKA
Phone No.
571-0198
Electrical Contractor (Company Name) Contractor License No. I Master Lic. No. (Plant Elect. Only)
MASTER ELECTRIC CO ,IHC CA01192
Mailing Address (Contractor or Owner Performing Installation)
Auth � i nature (Contractor or Owner Performing Installation) Phone No.
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!B-00001 - 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BA OF YELLOW COPY