P - 84106� I RE(,lUEST FOR ELECTRICAL INSPECTION �'TME�,
'�Il�ill IIII) IIIII IIIII IIIII IIIII IIIII IIIII IIIIIIII 1^g21 Univess ty A earRmf S1e 28ciSt. Paul, MN 55104 ��- �
* * Phone (612) 642-0800 �"���
03776693
Home Duplex Apt. Bldg. Other: New Addn
Remod Repair
Commercial Industrial Farm
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
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 accepted without the correct tee:
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 TOTA�S. J0
Sign/Outline Ltg. Xfmr.
Alarm/Remot . an#rpL -
Swimming Po Ll � � t.� I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In Date
Special Inspection „ Date
Final d —2� fiQ�
Investigative Fee �
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.
371-669 [� � �, s�
� 1=r � � �J� JOB NUMBER #9706000
PLEASE PRINT OR TYPE
Requ t a e Rough-in inspection required? ❑ Yes o Inspection Other Than Rough-In: Ready Now ❑ Will Call
(You must call the inspector when ready) Date Ready: .10/ 1% I 9%
I, j=,J licensed contractor ❑ owner hereby request inspection of the above electrical work at:
�o�n�d���treet, Box, o7R,��� No�T NE �`t�t I DLEY Z�p55432
Section No. Township Name or No. Range No. Fire No. County
AHOKA
Occupant Phone No.
HA2EEM MOHAMED 572-9834
Power Supplier Address
NSP MPLS OE'FICE
Electrical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Only)
MASTER ELECTRIC CO.,IMC. CA01192
Mailing Address (Contractor or Owner Performing Installation)
1�467 BOONE AVE S.SAVAGE MN. 55378
Author 'gn ure (Contractor or Owner Performing Installation) Phone No.
�,�'' � �`' "" 941 4712/890-3555
EB-00001A 11 /95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY