P - 84114� I II�I IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIII III) M8 n�e ota SsatOe B e LR of SR 1ot8, StNP PEMN IONo4
* 0 3 7 1 6 6 3 6* Phone (612) 642-0800
Home Duplex Apt. Bldg. Other: New
Commercial Industrial Farm Remod
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 ot the white copy only.
SAVER'S SWITCH INSTALLATIOH
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Addn
Calculate Inspection 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 TOTAI
Sign/Outline Ltg. Xfmr. 15. S0
Alarm/Remote Control
Swimmin Pool ' :' �
g I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In Date
Speciallnspection •
Final paro
Investigative Fee —Z--�"�1
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.
371-663 [� �
����� J J H NUMBER #9?06000
PLEASE PRINT OR TYPE
Requc�� 1'� � 9'7 Rough-in inspection required? ❑ Yes �Jo Inspection Other Than Rough-In: � Ready Now ❑ Will Call
(You must call the inspector when ready) Date Ready: 10I 1% I 9%
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
00261 67TH AVE NE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
ATIOKA
Occupant Phone No.
TIM MAHONEY 574-0738
Power Supplier Address
NSP MPLS OFFICE
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 BOOME AVE S. SAVAGE ![H. 55378
Authoriz i t (Contractor or Owner Performing Installation) ,"_"' ►± �-5 Phone No.
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EB-00001A-11 8/ STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY