P - 83745I I�i� IIII) (IIII IIIII IIIII IIIII IIIII IIIII IIII IIII
� *03639762*
REQUEST 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. X Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above ihe work covered by this request. Enter remarks in this space and on the back of the white copy only.
SAVER'S SWITCH INSTALLATIOH
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # Service Entrance Size Fee � Circuits/Feeders Fee I
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 �. �U
Sign/Outline Ltg. Xfmr. 15. �0'
Alarm/Remote Control
Swimming P I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Bo % E� Rough-In oate
}C Special Inspection i . Q/0
Final Dat ci
Investigative Fee ,Z-� /
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
�.�.� �_.� �.� .�.�.�.s.�,. ,..
OFFICE USE ONLY This request void 18 months from validation date printed in this box.
363-976� ,��� �
f`��� JOB NUMHER �97060�0
PLEASE PRINT OR TYPE
Request�ay� 17 �97 Rough-in inspection required? ❑ Yes �lo Inspection Other Than Rough-In: �( Ready Now ❑ Will Call
(You must call the inspector when ready) Date Ready: '� � 1'� � Cj'�
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
01020 67TH AVE NE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
ANOKA
Occupant Phone No.
YONGDA WANG 572-8661
Power Supplier Address
NSP MPLS OF'F'ICE
Electrical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Only)
MASTER ELECTRIC CO.,INC. CA@1192
Mailing Address (Contractor or Owner Performing Installation)
12467 BDONE AVE S.SAVAGE KN. 55378
Autho ' Si n ure (Co ra r or O er Performini� stallation) Phone No.
�+� � � � 941 4712/890-3555
EB-OOOOtA-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY