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REQUEST FOR ELECTRICAL INSPECTION ����
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Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104 �
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Phone(612)642-0800
New Addn
Other:
Remod Repair
Commercial Industrial Farm
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
' 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
ilculate Inspection Fee - This Inspection Request will not be accepted without the correct fee: Fee
Other
Fee # Service Entrance Size Fee # Circuits/Feeders
0 to 200 Amps 0 to 100 Amps
Mobile Home Park Stall Above 100 Amps
Street Ltg./Traffic Sig. Above 200 Amps
TOTAL
Transformer/Generator INSPECTOR'S USE ONLY 15. 50
Sign/Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming P ��� I hereby certify that I inspected the electrical installation described herein o Date dates stated
Irrigation Boo Rough-In
Speciallnspection te (�
� Final _ ._`��"
Investigative Fe� �
THIS INSTALLA A____ RDERED DIS � NECTED IF NOT COMPLETED WITHIN 18 MONTHS.
T � OFFICE USE ONLY This request void 1S months from validation date printed in this box.
371-668 [� ,��
�� "' ' �� JOB N MBER #9706Q►Q10
PLEASE PRINT OR TYPE
Requ�t�� 1%� 9% Rough-in inspection required? ❑ Yes �{Jo Inspection Other Than Rough-In: �( iea0d� i�' 9 i�Call
(You must call the inspector when ready) Date Ready:
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
City Zip Code
Job Address (Street, Box, or Route No.) FA I DLEY 55421
05408 ALTURA RD NE
Range No. Fire No. County
Section No. Township Name or No. ANOKA
Phone No.
� Occupant 572-9584
FREDERICK R MOEN
Power Supplier Address
�SP 1'iPLS OFFICE
Contractor License No. Master Lic. No. (Plant Elect. Only)
Electrical Contractor (Company Name) CA011�2
MASTER ELECTRIC C�7. , INC.
Mailing Address (Contractor or Owner Performing Installation) �
1�467 BOONE AVE S. SAVAGE MN. SS�..�%B PhoneNo.
Author' �g ture (Contractor or Owner Performing Installaticyt� !" ►'�� ��
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EB-OOOOtA- /95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY