P - 83601I II�I���IIII lllil illll IIIII IIIII Illll IIIII IIII Illl
*03923893*
REQUEST FOR ELECTRICAL INSPECTION ��,
Minnesota State Board of Electriciry �+' �� °i°
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 remarks in this space and on ihe back of the white cqoy only.
SAVEk'S SWiTCH INSTALLATION
Calculate Ins,oeciion Fee - This Insoection Request will not be accepied 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 TOTAI,r � 50
Sign/Outline Ltg. Xfmr. ����
Alarm/Remote o r
Swimming Po I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In Date
Speciallnspection '
Investigative Fee F`�i D te Z� � C�
�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OfFICE USE ONLY Tttis request void 18 months from validation date printed In this box.
392-389 � /S �
�a�
JOB NUMBER #9�506000
PLEASE PRINT OR TYPE
Requ e Rough-in inspection required? ❑ Yes o Ins ction O[her Than R
pe aigh-In: Ready Now ❑ Will Call
(You must call the inspector when ready) Date Ready: 1 1 I 30I g8
I, licensed contractor ❑ owner hereby request inspection of the above electrical work at:
�o����r�t,Box,o.�.Eto��np�E$ RD ��?IDLEY Z'P�432
Sectio� No. Township Name or No. Range No. Fire No. ��tY ANOKA
Occupant Phone No.
CHARLES PEREDA 792-0734
Power Supplier Address
��P MPLS OFF'ICE
Electrical Contractor (Compam Name) Contractor License No. Master Lic. No. (Plant Elect. Only)
MASTER ELECTRIC CO.,IMC. CA01192
Mailing Address (Contractor or Owner Performing Installation)
12467 BOONE AVE S. SAVAGE MM. 55378
Authorized S' nature (Contractor or Owner Perform n}� Phone No.
��� v � 941 4712/890-3555
EB-OOOOtA-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY