P - 83733i ! REQUEST FOR ELECTRICAL INSPECTION �'��
" I III�II I�III IIIIIIIIIIIIIII IIIIIIIIII IIIII IIII IIII 1ng21eUniveSs ty A earRmf SI 128CSt. Paul, MN 55104 ��„ �'
* 0 3 6 3 8 7 6 4* Phone (612) 642-0800 �"�'`A
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
I 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
Calculate Inspection Fee - This Inspection Request will not be accepied 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 TOTA�S
Sign/Outline Ltg. Xfmr. �
Alarm/Remote Control �
SWIf71f711i1g PO "� I hereby certify that I inspected the electrical instaltation described herein on the dates stated
Irrigation Boom Rough-In Date
Speciallnspection •
Final Dat
Investigative Fee Z �Z/—
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
�Y OFFICE USE ONLY This request void 18 months from validation date printed in this box.
363-876�] -� �ga
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JOB NUMBER #9706000
PLEASE PRINT OR TYPE
Request Rough-in inspection required? ❑ Yes o Inspection Other Than Rough-In: Ready Now ❑ Will Call
(You must call the inspector when ready) Date Ready: 7� 1/� 77
I, [� licensed contractor ❑ owner hereby request inspection of the above electrical work at:
�o�n�,�s�c�treet, Box, o��No�T NE �t�IDLEY Z�P��432
Section No. Township Name or No. Range No. Fire No. County
ANOKA
Occupant Phone No.
GARY L ['[ARTIN 571-8175
Power Supplier Address
NSP HPLS OFFICE
Electrical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Only)
!'IASTER ELECTRIC CO. , INC. CA01192
Mailing Address (Contractor or Owner Performing Installation)
12467 BOONE AVE S.SAVAGE MN. 55378
Auth ' d Sig ature (C tr ctor or Owner Performing Ins a� )� '; "j Phone No.
� g 941 4712/890-3555
�
� B-0OOO1A-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY
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