P - 83595! 41r111 IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIII IIII
*03923588*
REQUEST FOR ELECTRICAL INSPECTION ��
Minnesota State Board of Electricity �� °i
1821 University Ave., Rm. S-128, St. Paul, MN 55104 �,,�
Phone (612) 642-0800 �"� "` e
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 oi the white copy only.
�AVER'S SWITCH IHSTALLATION
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee n 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
Transtormer/Generator INSPECTOR'S USE ONLY TOTAL
Sign/Outline Ltg. Xfmr. , �'j�
Alarm/Remote C ntrol
SWIfIIfTllfl9 POOI� I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In Date
Special In$pection
Final Da � �±
Investigative � — J
THIS INSTALLA I A E ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validation date printed in this box.
392-358 � /5 �
�a�
JOB NUMBER #9�6000
PLEASE PRINT OR TYPE
Request Da� 3� � 98 Rough-in inspection required? Yes o Ins
1 1 Q O� pection Other Than Rough-In: [� Ready Now ❑ Will Call
(You must call the inspector when ready) Date Ready:
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
07337 CENTRAL AVE NE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
AxoxA
Occupant Phone No.
JAKES HEYREND 486-9297
Power Supplier Address
NSP MPLS 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) . �_
Authorized Signature (Contractor or Owner Performing Installation) Phone No.
EB-OOOOtA-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS O CK OF YELLOW COPY