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*03923570*
REQUEST FOR ELECTRICAL INSPECTION �,��
Minnesota State Board of Electricity � �'
1821 University Ave., Rm. S-128, St. Paul, MN 55104
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 of the white copy only.
�AVER'S SWITCH INSTALLATION
Calculate Inspection Fee - This Inspection Request will not 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 TOTA�� 50
Sign/Outline Ltg. Xfmr.
Alarm/Remote Control
SWlmming POOI I hereby certify that I inspected the electricai installation described herein on the dates stated
Irrigation Boom Rough-In Date
Special Inspection
inal Dat
Investigative Fee —
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 moMhs from validation date printed in this box.
392-357 � � fa � �s. sz�
JOB NUMBER #9'�60�0
PLE S I T TYPE
Requ e Rough-in inspection required? ❑ Yes ❑ o Inspedion Other Than Rough-In: Ready Now ❑ Will Call
4You must call the inspectw when ready) Date Ready: 1 1 I 3Q� I 98
I, licensed contractor ❑ owner hereby request inspection of the above electrical work at:
.iot��c�et, soX, o�a�,t�t��.OL ST N E �'� I DLEY Z'p',�°.�421
Section No. Township Name or No. Range No. Fire No. ��� ANOKA
Occu nt Phone No.
E�ENRY T HESSELGRAVE 572-6271
Power Supplier Address
NSP lLPLS OFFICE
Electrical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Only)
MASTER ELECTRIC CO.,INC. CA0I192
Mailing Address (Contractor or Owner Performing Installation)
12467 BOOtdE AVE S. SAVAGE MN. 55378
Authorized Signature (Contract or Owner Performing Installation) Phone No.
941 4712/890-3555
EB-00001A-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY