P - 81403i RE�UEST FOR ELECTRICAL INSPECTION .�'�
I���I) II I I II�II IIIII IIII I IIII � 8121 Universty ABea Rm SI128cSt. Paul, MN 55104 ���'
* 0 3 9 2 3 0 4 2* Pno� (s��� saz-oaoo '� �
Home Duplex Apt. Bidg. Other: New Addn
id. Htg. Equip. Water Htr. X Load Mgmt. Other:
Range Elec. Heat emp. Service
the work cove/ed by this request. Enter remarks in this space arrtl on the back ol the white copy arry.
SAVEk'S SWITCH INSTALLATION
Inspecfion Fee - Th�s In.$oection Requesf will not be accepted without fhe conect /ee:
Other Fee � Service Entrance Size Fee > Circuits/Feetlers
le Home Park Stall 0 to 200 Amps 0 to 100 Amps
�t LtgJTraffic Sig. Above 200_Amps Above 100 Am
;former7Generator INSPECTOR'SUSFONLV TOTA
�. Xtmr.
Gontrol
— — — Final
Investigative Fee
THIS INSTALLATION MAY BE ORDERE
392-304�
me
Fee
�� S0
�erein on �ne tlates sta[etl
�!�—S�—c�^^� J .i '1 S ' r %
DIS ____ ECTEO IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request mitl 18 monlhs irom valitlation tlate priMetl In ihis Mx.
/5�
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10P NUMRER #�b06�£�(?��D
�e4�'��(�C3 �9a Fough-in Inspec�ion requiretl� 0 Yes Q�JO Irispection Other Than FougM1-In: [� Ready Now 0 Will Call
�YOU mus� call Ihe inspac�or when reatly) pate Reatlg � ��� � y S
I, �] licensed contractor ❑ owner hereby request inspectlon of the above elactrical work at
Job Addrass (Slreel, Box, or qoule NoJ Gty Zip Cotle
00270 �7TH AVE NE FRIDLEY 55432
Section No. Township Name or No. Rar9e No. Fre No. Gounry
nNaxa
o����� ano�e No.
TERRI L TROLKE 571-5572
Power Supplier qCtlress
N5P MPL:� OFFICE
Elecincal Gontraotor IGOmpany Name) Gonirncior Llcense No. Master Gc. No. (Pla
MASTER ELECTRI� �u.,IYC. �A01192
Mailing Atltl�ess (Coritractor or Owrier Periormiqq Ins�allaipn)
1'�467 BQONE AVE S.:�AVAGE MN. a`.-�378
AWhoriz ignaWre (Conhac�or or Ownar Perforning Inetalla�ron)� ��� PFrone No.
� �41 �.�i._���1
EB-00001A-11 5/95 STATE BOPRO COPY - SEE INSTRUCTIONS ON BRCK OF VELLOW COPY