P - 84107� REQUEST FOR ELECTRICAL INSPECTION ��
I I I���IIIII IIIII IIII) IIIII IIII) (IIII III�I IIII II�I 1ng21eUn ves ity A earRmf SI 128cSt. Paul, MN 55104 � 0,4 �a
* 0 3 7 1 6 9 4 1 * 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 request. Enter remarks in this space and on the back of the white copy only.
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SAVER'S SWITCH INSTALLATION
Calculate Inspection Fee - This Inspection Request will not be accepted without the correcf 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
SWII71fTllllg PO(� �--: ���` ' I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom ao�9n-tr, Date
Special Inspection
Investigative Fee Final e O �
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.
371-694 � � ��
� � �7 � JOH NUMBER #970600Q►
PLEASE PRINT OR TYPE
Requ���l'� � C3'� Rough-in inspection required? ❑ Yes �[Jo Inspection Other Than Rough-In: � Ready Now ❑ Will Call
(You must call the inspector when ready) Date Ready: 1 0I 1 7I 9%
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
06311 7TH ST NE FRIDLEY 5543�
Section No. Township Name or No. Range No. Fire No. County
ANOKA
IOccupant Phone No.
STEVEN D TAKLE 571-7438
Power Supplier Address
NSP MPLS OFFICE
Electrical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Only)
MASTER ELECTRIC CO. IHC. CA01192
Mailing Address (Contractor or Owner Pertorming Installation)
12467 BOONE AVE S. SAV GE MH. 55378
Auth i ture (Contractor or Owner Performing Insta on ���; �. _� Phone No.
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I EB-00001 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY