P - 83565,I li�l I�'IIII IIIII IIIII IIIII IIIII I IIII IIIII IIII IIII
*039232$1*
REQUEST FOR ELECTRICAL INSPECTION �,�"��
Minnesota State Board of Electricity �5 �'
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800 '�?�'--�'�
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Cond. Htg. Equip. Water Htr. X Load Mgmt. Other:
Dryer Range Elec. Heat emp. Service
"X" above the work covered by ihis request. Enter remarks in ihis space and on the back of the white copy only.
SAVER'S SWITCH INSTALLATION
Calculate Inspection Fee - This Inspecfion Request will not be accepted without 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 TOTA
Sign/Outline Ltg. Xfmr. � 50
Alarm/Remote Control
Swimming Pool I hereby certiy that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In Date
�{ Special Inspec ' n
Final � Date
Investigative F �' ( f Z- l/^ p
THIS INSTALLATION MAY BE ORDERED DISCONNEC7ED IF NOT COMPLETED WITHIN 18 MONTHS._
�� �� OFFICFU§EbNLY This request void 18 months from validation date printed in this box.
392-32�1 ���� /.�
JOB NUMBER #9Q06000
PLEASE PRINT OR TYPE
Reque�t Dat�3� � 9g Rough-in inspection required? ❑ Yes ❑�do Inspection p[her Than Rough-In: [� Ready Now ❑ Will Call
11
(You must call the inspector when ready) Date Ready:
I, �] licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) Cdy Zip Code
00125 76TH WAY NE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. Counry �
AN�KA
Occupant PFrone No.
FREDERICK M ARBOUR 574-2408
Power Supplier Address
NSP PiPLS OFFICE
Electrical Contractor (Comparry Name) Contractor License No. Master Lic. No. (Plant Elect. Only)
MA�TER ELECTRIC �O.,INC. CA0119�
Mailing Address (Contractor or Owner Performing Installation)
12467 BOONE AVE S. SAVAGE KN. 55378
Authorized Signature (Contractor or Owner Performing Installation) . Phone No.
r,, ; S5�
EB-00001A-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS N CK OF YELLOW COPY