P - 83593.
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REQUEST FOR ELECTRICAL INSPECTION �,�'��
Minnesota State Board of Electricity � �'
1821 University Ave., Rm. S-128, St. Paul, MN 55104 ,,,�
Phone (612) 642-0800 ' c
'�:;�� .
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 cqoy only.
SAVER'S SWITCH INSTALLATION
Calculate Inspecfron Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee �s 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. �� 5�
Alarm/Remote Control
Swimming Pool I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boo � ao�9n-in Date
Special Insp
Final Date�
Investigative Fee
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request wid 78 months from validation date printed in this box.
392-367 � � !d � �s" 5�
J�B NUMHER #9$j0600@
PLEASE PRINT OR TYPE
Requ Rough-in inspection required? ❑ Yes ❑ o Inspection Other Than Rough-In: Ready Now ❑ Will Call
(You must call the inspector when ready) Date Ready: 1 1 I.�OI 98
I, licensed contractor ❑ owner hereby request inspection of the above electrical work at:
�o�rs�s1cs�reet,Box,or�sy.�.�A RD NE ��IDLEY Z'p�421
Section No. Township Name or No. Range No. Fire No. ��Ty ANOKA
Occupant Phone No.
Rl7BERT G KISHISH 572-9616
Power Supplier Address
NSP liPLS OFFICE
Electrical Contractor (Comparry Name) Contractor License No. Master Lic. No. (Plant Elect. Ony)
MASTER ELECTRIC CO.,IHC. CA01192
Mailing Address (Contractor or Owner Performing Installation)
12467 BOOHE AVE S V MN. 55378
Authorized Signat Contractor or Owner Perfor a C Phone No.
941 4712/890-3555
EB-00001A-11 S/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY