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*03788916*
REQUEST FOR ELECTRICAL INSPECTION ��;
Minnesota State Board of Electricity �� �'°
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800 ��`�' '�n
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.
SAVER'S SWITGH INSTALLATION
Calculate Inspection Fee - This Inspection Request will noi be accepted wrthout 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/Outiine 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 Rough-In Date
X Speci io 1. 50
Final e
Investi i a^ � �--
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
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OFFICE USE ONLY This request void 18 months from validation date printed in this box.
378-891�] � /S�
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JOB NUMHER #t9706000
PLEASE PRINT OR TYPE
RequeslAa�16 � 9� Rough-in inspection required? ❑ Yes [�No Inspection Other Than Rough-In: [�r Ready Now ❑ Will Call
O
� (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
06599 CHANNtEL RD NE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
AHOKA
Occupant Phone No.
SCOTT M GUSTAF'SOH 631-3237
Power Supplier Address
Hsp MPLS OE'FICE
Electrical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elect Only)
MASTER ELECTRIC C0. INC. CA0 192
Mailing Address (Contractor or Owner Performing Installation)
12467 BOONE AVE S.SAVAGE MN. 55378
� ed Signature (Contractor or Owner Performing Ins]�Ilat�n) Phone No.
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EB-00001A-1 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY