P - 84035� REQUEST FOR ELECTRICAL INSPECTION �;:...
I I I���II IIII) IIIII IIII) IIIII IIIII IIIII IIIII IIII IIII 1ng21eUni ess ty A earRmf SI 128cSt. Paul, MN 55104 � �cs
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' * 0 3 7 1 6 2 3 0'� Phone (612) 642-0800 '�.-°F
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Cond. Htg. Equip. Water Htr. X Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
, "X" above the work covered by ihis request. Enter remarks in this space and on the back of the white copy only.
SAVER'S SWITCH INSTALLATION
Calculate Inspection Fee - This Inspection Request will noi 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 ONLY TOTAL
Sign/Outline Ltg. Xfmr. 15. 50
Alarm/Remote Control
Swimming Pool I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rougn-in Date
Special Inspectio � , •
Final � /'� / e C"�'
Investigative Fee ' S,c�': t, __ ' 3 l �
THIS INSTALLATION MAY BE ORDERED DISCO ECTED IF NOT COMPLETED WITHIN 18 MONTHS.
s�. ��,-��„�
OFFICE USE ONLY This request void 18 months from validation date printed in this box.
371-623 [� �
/���y95 ��J
JOB NUMHER �9706000
PLEASE PRINT OR TYPE
Repu�t(� 17 � 9'� Rough-in inspection required? ❑ Yes [j}{Jo Inspection Other Than Rough-In: [X Ready Now ❑ Will Call
(You must call the inspector when ready) Date Ready: 10I 1% I9%
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
06655 ANOKA ST HE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
ANOKA
Occupant Phone No.
MICHAEL L CECKO 574-2145
'' Power Supplier Address
HSP HP[.S OFF'ICE
Electrical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Only)
MASTER ELECTRIC CO.,INC. CA01192
Mailing Address (Contractor or Owner Performing Installation)
12467 BOONE AVE S. SAVAGE ![N. 55378
Auth z �ature (Contractor or Owner Performing Installation) Phone No.
8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY