P - 83546III�fI�IIIiIfIiIIIIIIIiIIIIIIII1IIiI1IIIIII1IfIi REQUEIST FORVELEC sRjCA s{NP PEMNIONo4 ,����
Minnesota State Board of Electricity �
821 U' e sity e, Rm 8,
* 0 3 9 2 3 4 5 5* 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 ot the white copy only.
SAVER'S SWITCH INSTALLATION
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # Service EMrance Size Fee +� CircuitslFeeders 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 TOTAIJ� S0
Sign/Outline Ltg. Xfmr.
�i.�
Alarm/Remote Control
Swimming Pool I hereby certiry tha[ I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In Date
Special Inspect+on
Investigative Fee %� � � � g�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
,..r.^....r,.r-�....�...�..---.__-_�.-_�,---��-�._ _ __�, . .� . . , , , _ .
OFFICE USE ONLY This request void 18 months from validation date printed in this box.
392-34 � �- � / S�o
�
JOB NUMBER #9g06000
PLEASE PRINT OR TYPE
Req 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.�. 0I 98
I, licensed contractor ❑ owner hereby request inspection of the above electrical work at:
�o��s�c�treet, Box, oA�'�l��A ST NE ��"t I DLEY Z�P�432
i0
Section No. Township Name or No. Range No. Fire No. ��� ANOKA
Occupant Phone No.
ARTHUR O DEMEYERE 571-5249
Power Supplier Address
NSP MPLS OFFICE
Electrical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Only)
MASTER ELECTRIC CO.,INC. CA01192
Mailing Address (Coniractor or Owner Performing Installation)
12467 BO�NE AVE S. SAVAGE MH. 55378
Authorized Signature (Contra r or Owner Performing Installation) Phone No.
r—, 941 4712/890-3555
EB-00001A-11 8/95 STATE BOARD COPY - SEE I I NS�ON BACK OF YELLOW COPY