P - 82844, I IIIII�IIII IIIII (IIII IIIII IIIII IIIII IIIII IIII IIII
*03798899*
REQUEST FOR ELEGTRICAL INSPECTION �'��
Minnesota State Board of Electricity �� `"
1821 University Ave., Rm. S-128, St. Paul, MN 55104 �:
Phone (612) 642-0800 �"�'"'sf
Home Duplex Apt. Bidg. Other: �Q �. � New Addn
Commercial Industrial Farm Remod Repair
Air Cond. Htg. Equip. Water Htr. oad 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 cqoy only.
SAVER'S SWITCH INSTALLATION
Calculate Inspection Fee - This Inspection Request will nof 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 TOTAL 15.19�7
Sign/Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In Date
peciallnspection •
Final D C
Investigative F - --�� �"/
THIS INSTALLATION ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This req�st wid 18 months from validation date printed in this box.
379-889�] � � � � 3 ��
/ 5C�
JOB AIUMBER #970600
PLEASE PRINT OR TYPE
Request D Rough-in inspection required? ❑ Yes ❑ N Inspection Other Than Rough-In: ❑ ady Now ❑ Will Call
(You must call the inspector when ready) Date Ready: G/ 19 / S8
I, ❑`licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No. Cit Zip Code
00491 67T�i AVE NE �'RIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
ANOKA
Occupant Phone No.
LESLIE N NORDIH 571-3107
Power Suppiier Address
NSP MPLS OFFICE
Elecirical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Ony)
MASTER ELECTRIC CO.,INC. CA01192
Mailing Address (Contractor or Owner Performing Installation)
124b7 BOONE AVE S. SAVAGE I{N. 55378 .
Authorized Sign u ntractor or Owner Performing Installation) �]-O �� Phone No.
� Q
EB-00001A-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY �