P - 83476REQUEST FOR ELECTRICAL INSPECTION
`�I�IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII) 1^g2leUni essty A earRmf SI 128cSt. Paul, MN 55104 �.�e���e.
* n� 7�� g g y * 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 emp. Service
"X" above the work covered by this requesf. Enter remarks in this space and on the back of the white copy onty. II
SAVER'S SWITCH INSTALLATION
Calculate Inspection Fee - This Inspection Request will not be accepted withouf 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
Sign/Outline Ltg. Xfmr. 15. 50
Alarm/Remote Control
Swimming Pool I hereby certify that I inspected the electrical installation described herein on the dates stated
I I'1'Igd Rough-In Date
X SPe � '1 . 50 ,
Final �
Investigative Fee � " �� '�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 ONTHS.
OFFICE USE ONLY This request void 18 months trom validation date printed in this box.
378-898� � ,s - �
�i3�
JOB NUMHER �9706000
PLEASE PRINT OR TYPE
Reques��16 � gg Rough-in inspection required? ❑ Yes �Jo Inspection Other Than Rough-In: � Ready Now � Will Call
(YOU must call the inspector when ready) �ate Ready: (� / 16 / c�8 �
I, f'I licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
00136 71 1/2 WAY NE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
ANOKA ;
Occupant Phone No.
COhIAL P MAHADEO 574-0112
Power Supplier Address �.
H�P MPLS OFFICE ;
Electrical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Only) I,
HASTER ELECTRIC C0. , IKC. CA011'32 1
Mailing Address (Contractor or Owner Performing Installation) �
124fi7 BOONE AVE S. SAVAGE MN. 55378
Aut' iz ig ture (Contractor or Owner Performing Installation) Phone No.
EB-00001A-11 /95 STATE BOARD COPY - S I S O ON BACK OF YELLOW COPY j
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