P - 83663�-II�II� �I IIIII IIIII IIIII IIIII IIIII (IIII IIII IIII
* 0 3 6 3 8 5 8 2*
REQUEST FOR ELECTRICAL INSPECTION ���
Minnesota State Board of Electricity � °'
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800 �"� c
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 wo�k covered by this request. Enter remarks in this space and on the back of the white copy only.
SAVER'S SWITCH INSTALLATIOH II
Calculate Inspection Fee - This Inspection Request will not be accepted without ihe correct fee: II
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.
Alarm/Remote Control
Swimming Pool I hereby certify that I inspected the electrical instaliation described herein on the dates stated
Irrigation Boom Rough-In Date
Special inspection •
Final � ' �-' . ate � .
Investigative F -�#.c...�.�-�---. � '� �3'
THIS INSTALLATION M ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validation date printed in this box. �i
363-858� � ���� ',
I � �� � �� I
JOH NUMBER �9706000
PLEASE PRINT OR TYPE i
Request 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
I, [� licensed contractor ❑ owner hereby request inspection of the above electrical work at: I
�o�n��s��reet, Box, o���� ST NE �t�2IDLEY Z�PS��432
Section No. Township Name or No. Range No. Fire No. County
ANOKA I
Occupant Phone No.
liICHAEL ALLEN LAFAVE 780-2366 I
Power Supplier Address
NSP tiPLS OF'PICE I
Electrical Contractor (Company Name) Contrector License No. Master Lic. No. (Plant Elect. Only)
MASTER ELECTRIC CO.,INC. CA01192 �
Mailing Address (Contractor or Owner Performing Installation) I
12467 BOONE AVE S. SAVAGE MN. 55�378 I
Authorize �gnature tractor er Performing Installation) Phone No.
R 941 4712/890-3555
EB- 001A-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY
�