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RE(�UEST 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 onty.
SAVER'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 iNSrecroR•s use oN�r TOTAL
Sign/Outline Ltg. Xfmr. %�. 50
Alarm/Remote Control
Swimming Po I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In Date
Speciallnspection •
Final Date
Investigative Fee _ 'Z —
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WIT N 18 MONTHS.
OFFICE USE ONLY This r�st void 18 rta�ths from validation date printed in this box.
392-391 � �s3�
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JOB NUMBER #9�06000
PLEASE PRINT OR TYPE
Reque�t �ay€ �0 � cjg Rough-in inspection required? ❑ Yes ❑�lo Inspection Other Than Rough-In: � Ready Now ❑ Will Call
(You must call the inspector when ready) Date Ready: Z i� 30 � 98
I, u licensed contractor ❑ owner hereby request inspection of the above etectrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
06610 CHANHEL RD NE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
ANOKA
Occupant Phone No.
LAWRENCE PERRON 572-986?
Power Supplier Address
MSP liPLS OFFICE
Electrical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Ony)
MA�TER ELECTRIC CO.,ING. CA01192
Mailing Address (Contractor or Owner Performing Installation)
12467 800ME AVE S. SAVAGE iKN. 55378
Authorized Signature (Contractor or Owner Performing Installation) Phone No.
941 471�/890-3555
EB-00001A-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY