P - 83404,�!IIII111111 IIIII IIIII IIIII IIIII IIIII IIIII IIII IIII
*03788924*
REQUEST FOR ELECTRICAL INSPECTION �,���
Minnesota State Board of Electricity °i
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 Temp. Service
"X" above the work covered by this request Enter remarks in this space and on the back of the white cqoy only.
SAVER'S SWITCH IHSTALLATION
Calculate lnspection Fee - This In$oection 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 TOTAL
Sign/Outline Ltg. Xfmr. 15. 50
Alarm/Remote Control
Swimming Pool I hereby certify that I inspected the electrical installation dese��A (MwY1 p1 � �Y{
Irrig ' om Rough-In D�M�
Sp I
Final
Investigative Fee �--`---
THIS INSTALLATION MAY gE ORQERED DISCO D IF NOT COMPLE?ED WflHIN 1a 0 IS.
_.. ____ ___._.._,rK
OFFICE USE ON�Y This requsd vpid 18 months fran validNipn date printed in this box.
378-892� ,�
• yi��
JOH NU!lBtR �9706000
PLEASE PRINT OR TYPE
Reques1�16 � lj8 Rough-in inspection re uired?
q ❑ Yes �(Jo Inspection Other Than Rough-In: � Ready Now ❑ Will Call
(You must call the inspecfor when ready) Date Ready: fj I 1 C] I98
I, �] licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
00140 CHRISTENSON CT NE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
ANOKA
Occupant
Phone No.
STEPHEN JANOWIEC 571-8425
Power Supplier Address
NSP MPLS OFFICE
Electrical Contractor (Comparry 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 MN. 553?8
ed ignature (Contractor or Owner Performing Installation) Phone No.
941 4712/890-3555
EB'���?-� $�95 STATE BOARD C P- UCTIONS ON BACK OF YELLOW COPY