P - 83591� ��I� III�I IIIII IIIII IIIII IIIII III�I IIIII IIII IIII
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REGIUEST FOR ELECTRICAL INSPECTION �,���
Minnesota State Board of Electricity °i
1821 University Ave., Rm. S-128, St. Paul, MN 55104 �� -
Phone(612)642-0800 �
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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 fhis request. Enter remarks in this $oace and on the back of the white copy only.
SAVEFt'S SwITCH INSTALLATION
Calculate Inspection Fee - This Inspection Request will not be accepted without the conect 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�� 50
Sign/Outline Ltg. Xfmr. �
Alarm/Remote Cond'd
Swimming Pool i r,,,,�, �;y �t i;,,,p,�� �� e�;,;��i insra�etan deaaibea Ir�rin an: dates stated
Irrigation'Boom Ftaqn-m �
Special Inspec � -
Final —O �
Investigative Fee C�—� i
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN �8 MONTHS.
_ --- ---------------- -- --- ----�----_� ..,-
- -- -- -, . ---�-.
OFFICE I/dE ONLY 7his request void 18 months from validation date printed in this box.
392-413 � � � � �
JOB NUMHER #9�06000
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� 30 i 98
I, u licensed contractor ❑ owner hereby request inspection of the above electrical work at:
J�0763�8reet,Box,oBRt�GADOON PL NE F�IDLEY Z�p�432
Section No. Township Name or No. Range No. Fire No. County ANOKA
Occupant Phone No.
RAYMOND E WILLIAMS 7B4-4526
Power Supplier Address
N5P MPLS OF'FICE
Electrical Contractor (Comparry Name) Contractor License No. Master Lic. No. (Plant Elect. Ony)
MASTER ELECTRIC CO.,INC. CA01192
Mailing Address (Contractor or Owner Perfaming Installation)
12467 BOOHE AVE S. SAVAGE MN. 55378
Authorized Signature ntractor or Owner Performing Installati �.y Phone No.
�� / � 941 4712/890-3555
EB-00001A-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY