P - 83597i ii�iiii iiiii iiiii iiiii iiiii iiiii iiiii ii�i iiii
*03923901*
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 �emarks in this space and on the back of the white copy only.
SAVER'S SWITCH INSTALLATION
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
Transformer/Generatar. wsPecrorrs use oN�v TOTAL
Sign/Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Poo I hereby certiry that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In oate
Special Inspection
Fnal D e
Investigative Fee —
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
� OFFICE USE ONLY This request wid 18 rrronths from validation date printed in this box.
392-390 �,s �
�a �
JOB NUMBER #9$06�00
PLEASE PRINT OR TYPE
Reque� �� 30 / 98 Rough-in inspection required? ❑ Yes I"l.No Inspedion Other Than Rough-In: 17� Ready Now ❑ Will Call
—li �i
(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
07370 CONCERTO CURV FRIDLEY 55432
Section No. Township Name or No. Rarge No. Fire No. County
ANOKA
Occupant PFwne No.
CHESTER W PERKERWICZ 7 -
Power Supp�ier Address
NSP MPLS OFFICE
Electrical Contractor (CompaM Name) Contractor License No. Master Lic. No. (Plant Elect. Ony)
MASTER ELECTRIC C0. INC. CA01192
Mailing Address (Contractor or Owner Perfwming Installation) .
Authorized Sign Contractor or Owner Performing Installation) Phone No.
EB-00001A-11 8/95 STATE BOARD COPY - SEE INSTR S N OF YELLOW COPY 0-3555