P - 83004� I�I�i IIIII IiIII IIIII II II I IIIII IIIII IIIII IIII IIII
*03798485*
REQUEST FOR ELECTRICAL INSPECTION ��
Minnesota State Board of Electricity � °i
1821 University Ave., Rm. S-128, St. Paul, MN 55104 �.. �
Phone (612) 642-0800 �"�='�°"
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm �� S� Remod Repair
Air Cond. Htg. Equip. Water Htr. oad Mgmt. Other:
Dryer Range Elec. Heat emp. Service
"X" above ihe work covered by this request. Enter remarks in this space and on the back of the white copy only.
SAVER'S SWITCH INSTALLATIOH
Calculate Inspection Fee - This Inspecfion Requesi 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 S O
Sign/Outline Ltg. Xfmr. 15. ��"
Alarm/Remote Control
Swimming Pool I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In �ate
pecial Inspection '-j• 0 �na�
Investigative Fee � — S �
� STALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS. �
�_ ..Y-� r_� --------------------- --- —
OFFICE USE ONLY This request wid 18 months 6om validation date printed in this box.
379-848�] , � o ,
'� �� �J�9 JOB NUMBER #k970600
PLEASE PRINT OR TYPE
Request Dag � 1 C, � Cj� Rough-in inspection required? ❑ Yes ❑ N�( Inspection Other Than Rough-In: ❑�ady Now ❑ Will Call
(YOU must call the inspector when ready) �ate Ready: fj / 1 c� / C38
I, ❑Kicensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
06853 7TH ST NE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
ANOKA
Occupant Phone No.
WALI.ACE JAHN 571-3577
Power Supplier Address
NSP MPLS OFFICE
Electricai Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Ony)
MASTER ELECTRIC CO. INC. CA01192
Mailing Address (Contractor or Owner Performing Installation)
Authorized Signa r( tractor or Owner Performing Installation) Phone No.
264 p
E&00001A-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY