P - 84049'' I�I�IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII REQUESTFORELECTRICALINSPECTION .��� ,
Mmnesota State Board of Electncity �
1821 University Ave., Rm. S-128, St. Paul, MN 55104
* 0 3 7 1 6 6 7 7* Phone (612) 642-0800 ���°��``F i
Home Duplex Apt. Bldg. Other: New Addn I
Remod Re air
Commercial Industrial Farm P
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat emp. Service
"X" above the work covered by this request. Enier remarks in this space and on the back of the white copy onty. l i
SAVER'S SWITCH INSTALLATION
�alculate Inspection Fee - This Inspection Request will nof be accepted without the co�rect 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. 1 rJ' . 50
Alarm/Remote pntrol
Swimming Pool � I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In Date
Special Inspection
Final Date—. �/
Investigative Fee 0
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validation date printed in this box.
371-667 �
��� y� 5 /�, sZ��
JOB NUMBER #9706000
PLEASE PRINT OR TYPE
Reque�1��21'� � ij'� Rough-in inspection required? ❑ Yes [�Jo Inspection Other Than Rough-In: [� Ready Now ❑ Will Call
(You must call the inspector when ready) Date Ready: 10I 1% I 9%
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
00295 ELY ST NE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
ANOKA
Occupant Phone No.
DENNIS W MILLER 783-2863
Power Supplier Address
HSP MP[.S OFFICE
Electrical Contractor (Company Name) Contractor License No.
MASTER ELECTRIC CO.,INC. CA01192
Mailing Address (Contractor or Owner Performing Installation)
12467 BOONE AVE S. SAVAGE MN. 55378
Authpyfc$�igqyture (Contractor or Owner Performing Installatio�
EB-00001AV]�8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY
Master Lic. No. (Plant Elect. Only)
Phone No.