P - 83084I II��I �Ill� (III� (IIII �I�I� Ilt�l (II�I IIIII (I�I I�II 1n82�1 U�niverstyOAve.LRm. SR 1C8, St PaPEMN ION04 ����'
' * 0 3 8 6 9 9 5 5'r Phone (612) 642-0800 ���_�
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Cond. Htg. Equip. Water Htr. oad Mgmt. Other:
Dryer Range Elec. Heat emp. Service
"X" above the wak covered by this request Ente� remarks in this space and on the back ot the white copy only.
SAVER'S SWITCH INSTALLATION
Calculate Inspection Fee - This Inspection Request will not be accepted without the conect 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 15. �0
Sign/Outline Ltg. Xfmr.
Alarm/Remote ol
Swimming Poo I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In Date
peciallnspection ' _��
Final e
Investigative Fee �
THIS INSTALLATION MAY BE ORDERED DISCO NECT'ED IF NOT COMPLETED WITHIN 18 MONTHS.
�..�--- — — -- — ----C---
OFFICE USE ONLY 7his request voitl 18 months from validation date priMed in this box.
386-995�] � /S
�/�
JOB NiJMBE�#970600
PLEASE PRINT OR TYPE
Request Da Rough-in inspection required? ❑ Yes
❑ N inspection Other ihan Rough-In: ❑ Now ❑ wil Call
(You must call the inspector when ready) Date Ready: 8I S 4I 98
I, ❑ licensed conMactor ❑ owner hereby request inspection of the above electrical work at:
Job���t,Box,orR��,� AVE. NE °itj`FRIDLEY Z'��5432
Section No. Township Name or No. Range No. Fire No. ��� ANOKA
��P��HERESA M VAN L.ITH PhoneNO. S?�-383�
Potn�r Supplier Address
NSP MPLS OPFIC�
Electrical Contractor (Company Name) Contractor License No, Master Lic. No. (Plant Elect. Ony)
MASTER ELECTRIC CO.,INC. CA01192
Mailing Address (Contractor or Owner Performing Installation)
12467 BDOME AVE S. SAVAGE IYN. 55378
Authorized Signatur ( ractor or Owner Performing Installation) Phone No.
94 -4712/890-355
EB-00001A-11 8/95 STATE BOARD COPY - SEE IN B�CK OF YELLOW COPY