P - 84116II�II�IIIIIIIIII IIIIIIIIII IIIIIIIIIIIIIIII�IIIIII R8 QU�ESe SFORve.LRm. SR1C8 St NSPEnCNION04 ����t
Minnesota State Board of Electricity �
* 0 3 7 1 6 7 1 9* Phone (612) 642-0800 ������
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
I"X" above the work covered by this request. Enter remarks in this space and on the back ot the white copy only.
I SAVER'S SWITCH INSTALLATI�N I
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 ONLY TOTALS. 'rJ0
Sign/Outline Ltg. Xfmr. 1
Alarm/Remote Control
Swimming Poo1F' ;'� � ��� ~ I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom �Y Rough-In Date
Special Inspection
Final Dat.
Investigative Fee —� �—�- � — �'�
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.
371-671 � � ���Z�
� � �(�� JOB NUMBER #9706000
PLEASE PRINT OR TYPE
Requ e Rough-in inspection required? ❑ Yes o Inspection Other Than Rough-In: Ready Now ❑ Will Call
(You must call the inspector when ready) Date Ready: 10 � 1%� 9/
I, licensed contractor ❑ owner hereby request inspection of the above electrical work at:
�o����treet,Box,o�r��a AVE HE �'i�IDLEY Z"��'432
Section No. Township Name or No. Range No. Fire No. County
AxoxA
Occupant Phone No.
JOE W MURPHY 574-9535
Power Supplier Address
NSP MPLS l7FE'ICE
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 BOOHE AVE S. SAVAGE MN. 55378
Auth z ' ature (Contractor or Owner Performing Installation) Phone No.
'° w, � °- 941 4712/890-3555
�
=6-00001 - 8/95 STATE BOARD COPY - SEE INSTRUCTIO S O BACK OF YELLOW COPY