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Minnesota State Board of Electriaty �
* 0 3 7 9 8 2 g 7* Phone (612) 642-0800 �'-�'"�`"
Home Duplex Apt, Bldg. Other: �� s� New Addn
Commercial lndustrial Farm Remod Repair
Air Cond. Htg. Equip. Water Htr. oad Mgmt. Other:
Dryer Range Elec. Heat emp. Service
"X" above the work covered by ihis request Enter remarks in this space and on the back of the whiie cqoy only.
SAVER'S SWITCH INSTALLATIOH
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 ONLV TOTAL �j �
Sign/Outline Ltg. Xfmr. 15•��
Alarm/Remote Control
Swimming Pool I hereby certify that I inspected the electrical installation described herein on [he dates stated
Irrigation Boom Rou9n-tr, Date
peciallnspection S. 0 Final Dat�
Investigative Fee � 6 r��
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.
379-828�] �� �
15
��J��� J�B NUMHER �970600
PLEASE PRINT OR TYPE
Request D� � 1 g� 98 Rough-in inspection required? ❑ Yes ❑ NOx Inspection Other Than Rough-In: ❑ 1�2ady Now ❑ Will Call
(You must call the inspector when ready) Date Ready: �
I, ❑�icensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
01423 76TH AVE NE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
ANOKA
Occupant Phone No.
KEN A ERICKSON 792-9654
Power Supplier Address
NSP MPLS OFFICE
Electrical Contractor (Comparry Name) Contractor License No. Master Lic. No. (Plant Elect. Only)
MASTBR ELECTRIC CO.,INC. CA01192
Mailing Address (Contractor or Owner Performing Installation)
12467 BOONE AVE S.SAVAGE MN. 55378
Authorized Signatur ( ntractor or Owner Performing Installation) Phone No.
26 94 —4712/8 0-35
EB-00001A-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY