P - 81393I�I IIIII I II II II III I I II I I II
*03923836*
REQUEST FOR ELECTRICAL INSPECTION �,�,�,.
Minnesota State Board of Elechicity °'--
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 Hir. X Load Mgmt. Other:
Dryer Range Elec. Heat emp. Service
"X" above the wo�k covered by this iequesL Enter remarks in this space and on the back o/ the white copy only.
SAVER'S SWITGH INSTALLATION
Calcu/a[e In`pection Fee - This Inspecfion Request will nof be acceptetl without the conect /ee.�
Other Fee # Service Entrance Size Fee � Circuils/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street LtgJTraffic Sig. Above 200 Amps Above 100 Amps
TransformeNGenerator INSPECTOR'S USE ONLY TOTA
Sign/Outline Ltg. Xfmr. k� 50
Alarm/Remote Control
SWifllfllillg POO � heryby certlty Nal I inspectetl tM1O alechical ins�allatlon aesaibetl hereir m ihe dates sffited
Irrigation Boom aouGn-in oaie
X Speciallnspection 1 . 50
Final q�te �� �
Investigative Fee _]
THIS INSTALLATION MAY BE ORpERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONT S.
OFFICE USE ONLY This request void 18 mcn�hs imm valitlation Cate priritetl in ihis box.
392-38�] , �5 �,
�a�
JOB NUMHER #9a06fd0Ch
PLEASE PRINT OR TYPE
Rea��� qa}�3� � gg RougM1-in mspection requiretl? � Ves �o Inspec�ion O�her TM1an Rou9h-In: �{ ReatlY Now 0 WII Call
(rou musi ren me ���soea« wne� �eaav� oeca Rasdr: 11 / 30198
I, 4 licensed contractor ❑ owner hereby request inspection of the above electrical work at
.bb Atltlress (Sireet, Bax, ar Rou�a No.) CI�y Zlp Gode
06140 7TH ST NE FRIDLEY 55432
Section No. TownsM1ip Name or No. Range Na Fire No. County
ANCIKA
Occupant Phone No.
r]S4'AR MIRANDA 574-9249
Power Supplier Pfldresa
NSP MPLS OFFICE
Elecirical Conheclor (GOmpany Name) Cor�motor Gcense No. Master Go. No-IPlant Elect Only)
MASTER ELECTRIC CO. INC. CAtdl192
Mailing Adtlress (COntractor or Owrier Per�ormirg Ir�stallatron�
12467 BQQNE AVE S. S'AVAGE MN. 55378
Authorized SgnaWre (Contractor or Owner Pertorming InsYallelion) ,�r Phorie No.
26 �
., � «-
EB-00001A-11 8/95 STATE BOARD COPV - SEE INSTRUCTIONS ON BACK OF VELLOW COPV