P - 83600, I��I IIIII IIIII IIIII IIIII IIIII IIIII Iilll illl IIII
*03923463*
REQUEST 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. Bidg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Cond. Htg. Equip. Water Htr. X 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 only.
SAVER'S SWITCH THSTALLATION
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 iNSPecroR•s use oN�v TOTAL,��
Sign/Outline Ltg. Xfmr. �. 50
Alarm/Remot Control
SWIfTlf111119 P�� I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In Date
X Speciallnspection 1 . 50
Final f Dat
Investigative Fee _. . - - "Z o— f''
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
� OFFICE USE ON�Y This 2quest void 18 months from validation date printed in this box.
392-346 ��-�
��
J�B HUMBER #9$06000
PLEASE PRINT OR TYPE
Reque�t �a� 3� � 9$ Rough-in inspection required? ❑ Yes j]�o Inspection Other Than Rough-In: � Ready Now ❑ Will Call
(You must call the inspector when ready) Date Ready: 1 1 J 30I98
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
05520 E BAVARIAN PAS FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
AHOKA
Occupant Phone No.
DEHISE M DOW 571-2232
Power Supplier Add2ss
NSP MPLS OF'FICE
Electrical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Ony)
liASTER ELECTRIC Ci7. , INC. LA01192
Mailing Address (Contractor or Owner Performing Installation)
12467 BDONE AVE S. SAVAGE MH. 553'78
Authorized Signature trac[or or Owner Pe mi Installation) Phone No.
� � I 941 4712/890-3555
EB-00001A-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY