P - 83658II�Ef1IIlIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII MEQesota S atOe BoaLd of EReCActyNSPECTION �;��„�� I
r 1821 University Ave., Rm. S-128, St. Paul, MN 55104
* 0 3 6 3 9 1 6 8* 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 Temp. Service
"X" above the work covered by this requesi. Enter remarks in this space and on the back ot the white copy only.
SAVER'S SWITCH IHSTALLATION
Calculate lnspection 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 ONLV TOTALS •!ee,_
Sign/Outline Ltg. Xfmr. 1
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
Special Inspe
Final Da `2 � �
Investigative ee
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
� OFFICE USE ONLY This request void 18 months from validation date printed in this box.
363-916�] �
f �"�o � � ��� JOB HUMBER �9706000
PLEASE PRINT OR TYPE
Request e 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%� 9%
I, licensed contractor ❑ owner hereby request inspection of the above electrical work at:
�o�,���treet,Box,o�,���EL RD NE �`�IDLEY Z��432
Section No. Township Name or No. Range No. Fire No. County
ANOKA
Occupant Phone No.
B w PORTER 574-0063
Power Supplier Address
NSP MPLS OF'F'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)
12467 BOONE AVE S. SAVAGE ltN. 55378
Autho� Signat�re�Contracto�r Owner Performiny Ins[allation) Phone No
I EB-00001A-11 8/g5 STATE BOARD COPY - SEE
941 4712/890-3555
OF YELLOW COPY