P - 81390�" f�Iflllllllllllllllllllli(IIIIIIIIIIIIIIIIII illl M$ n�Uoia �tatOe BoarRof E�IeCScSt PaWEMN 5OSN04 ���
' 0 3 9 2 3 6 4 6* Pno�e �siz� sa2-oaoo ����*•.-�
Home Duplex Apt Bldg. Other: New Addn
qwp. vvater Htr. ^ Load Mgmt. Other:
Elec. Heat Temp. Service
by thrs requesf Enfer remarks in this space and ar the back of the white copy
SAVER'S SWITCH INSTALLATION
wlafe lnspectiDn Fee - This Inspecfion Reques[ will not be accepteU without 6ie oo�ec( (ee:
Other Fee � Service Entrance Size Fee u Circuits/Feetlers Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 2C0 Amps A6oi;e 100_Amps
TransformeNGenerator INSPECTOR'S USE ONLV TOTA
Sign/Outline Ltg. Xfmr. �� Sm
—°�� �•• •°� �� •� v v V I hEreby certly [hat I ins0ected �he el�incal Instailetion describeC herein on Ihe tlates statetl
�!llyd11011 BDOIII ' Rough-In Date
Special Inspection
ri�ai
hvestigative Fee � I°at�—/C _ f 9'
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
�` a� OFFIGE'.SE ONLY This request voltl 18 monlhs imm valitlaUOn da[e prirted ir ihls box.
392-36�] �/d6 $ �
JOH NUMBER #9-'�'j06HC�0
PLEASE PRINT OR TYPE
Requeg �a(� 3 � 98 Rou�h-in Inspection raquired? p Ves ��c Inspzction O�her TFan Rmgh-Ir: [}{ Rcatly Nav � Will Call
(VOUmustaall�helnspec[orwhenreetlyj DateReady: 11����98
I, [� licensed contrac�or ❑ owner hereby request inspecfion of Ihe above electrical work aL
�oa�p��7�Lneaceox,o6���tN��`uT NE ��2ZDLEY zip55432
Sec[ion No_ Township Nzme w Nci Ren9e No. flre Na_ Caunty
ANOKA
Occupant ���r ��.
KAROL A JOHNSON 571-5104
PoWar Supplier Atltlress
�y�p MPLS OFFICE
EI¢c�ncal ConVaotor IGOmpeny Name) Conhaclor Llcense No. Mas�er Lic Nn �Plant Efe
MASTER ELECTkIC C0. � IiiC. CA�D1192
Mailing Adtlress (Conhetlor or Owner Pedorming Iristallatlon)
i'�'.467 BIlONE AVE S. SAYAG6 MN 378
AutMdzed SgnaWre (COntractor or Owner Performing Instal�atlon) ' Phorre No.
94I �712/89@—
i
� EB-00001A-11 9�95 SiATE BOARD COPY - SEE MSTRUCTIONS ON BACK OF YELLOW COPV
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