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*03804325*
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 ��� S� Remod Repair
Air Cond. Htg. Equip. Water Htr. X 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 of the white copy only.
SAVER'S SWITCH INSTALLATION
Calculaie Inspection Fee - This Inspection Request will not be accepted wiihout 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 ONLY TOTAL !S`i �S'O
Sign/Outline Ltg. Xfmr. r��
Alarm/Remote Control
Swimming Pool I hereby certify thaf I inspected the eledrical installation described herein on the dates stated
Irrigation Boom Ro�gr,-in Date
K Special Inspection 1. 50 Final �
Investigative Fee i � � �
THIS INSTALLATION MAY BE ORDERED DISCON CTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validation date printed in this box.
380-432�5]
,�j �� ��3i� �
� `" � JOB NUMBER #970600�
PLEASE PRINT OR TYPE
Request �t� 07 ! 98 Rough-in inspection required? 0 Yes ❑�o Inspection Other Than Rough-In: ❑XReady Now ❑ Will Call
(You must call the inspector when ready) Date Ready:
I, j� licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
00410 67TH AVE i1E FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
ANOKA
Occupant Phone No.
JEAN E HAGEL 571-7650
Power Supplier Address
N5P MPLS Of'F'ICE
Electrical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Only)
liASTER ELECTRIC CO. , INC. CA01192
Mailirx,7 Address (Contractor or Owner Performing Installation)
12467 BOCINE AVE S. SAVAGE MN. 55378
Authorized Sign tu ( ntractor or Owner Performing InstallatiyK � • Phone No.
�� � � � 941 4712/890-3555
EB-00001A-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY
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