P - 81400IIIII I II I I I IIIII Ilfl III
* 0 3 9 2� 6 2 �*
REQUEST FOR ELECTRICAL INSPECTION s��,
Minnesota State Board of Electricity � 3�,
1821 University Ave., Rm. 5-128, St. Paul, MN 55104 ����-
Phone (612) 642-0800 �^�_�
Home Duplez Apt Bldg Qther�. New Addn
Commercial Industrial Farm Remod Repair
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elea Heat emp. Service
"X" above [be work coveretl by this request En[er remarks �n this space antl on the back of the white copy only.
SAVER'S SWITCH INSTALLATION
Calcula[e Inspecfbn Fee - This Inspection Request will not be accepted without the correcf /ee:
Other Fee � Service Entrence 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'SIlSEONLY TOTA
Signi Outline Ltg. Xfmr. �• 5@
Alarm/Remote Conhol
Swimltli0g P I hereby certity mat I Insoectea ine eiwvica� ins�allation dascribed nerein on tne tlates stetatl
�fflJd{IOfIBOOfII Rough-In �ate
x Special Inspection 1. 50 F_ a o �
Investigative Fee � J�
THIS INSTALLATION MAY BE OR�ERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This reQUest witl 18 months tmm validation tlate pnnted in �hls box.
392-36� • �5 �
�a6
JOB Nl1MBER i19�060iD0
PLEASE PRINT OR 7VPE
Faque [ a / RmSh-in inspection required7 � Ves ❑ o InspeoEOn 0[I�er Than RougMn: Reatly Now � Wtll Gall
(YOU must oell the Inepector wnen reatly� Date Re tly: 11 /�Q�/ 98
I, Lry licensed wnhactor ❑ owner hereby request inspection of Ihe above elechical work at
Job Pddres (Sheet, Box, or Route No_) Cp Zip Cotle
00357 66TH AVE NE FYRIDLEY 55432
Seclion No. Township Name or No. Range Na Fire No_ Gounty
ANOKA
Ccoupan[ Phorie No
At�lTHONEY P TAWDRSKI 271-73'73
Po�re, s�vv��, naa�ess
NSP PiPLS' OFFICE
Electrkal Conhec[or (GOmpany Nemel Contractor Gcense Na �Aastu lic. No. (Plank ElecG Ov.O��
MASTER ELELTRIC Ct7.,INC. CA02192
Melling Htltl�ess (COntraotor o� Owner Performing Installation]
124b7 SIIONE AVE 5.SAVAGE MN. 55378
Au[horizetl SlBnature onhactor or Owner PerPorming Installatan� � n^,�, Phone No-
d��_ �
��J�� 941 4?12/890-3555
E&00001A-11 8i95 STATE BOAFO COPV - SEE INSTRUCTIONS ON BACK OF VELLOW COPY