P - 82843I I�I��III I IIIII I'll) IIIII IIIII IIII) IIIII IIII IIII
*03798998*
REQUEST FOR ELECTRICAL INSPECTION ��
Minnesota State Board of Electricity � �'
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800 ��`;�'''s
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm �� `� c Remod Repair
Air Cond. Htg. Equip. Water Htr. oad Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above fhe work covered by this request. Enfer remarks in this �oace and on the back of the white cqoy only.
SAVER'S SWITCH INSTALLATION
Calculate Inspection Fee - This /nspeciion 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 IMSPECTOR'S USE ONLY TOTAL �
Sign/Outline Ltg. Xfmr. 15.180'
Alarm/Remote Control
Swimming Pool I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In Date
peciallnspectio • F�� �
Investigative Fe
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMP�ETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months from validation date printed in this box.
379-899�]
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Jt]B HU?lBER �970600
PLEASE PRINT OR TYPE
Reques[ Da Rough-in inspection required? ❑ Yes ❑ N Inspection Other Than Rough-In: ❑ dy Now ❑ Will Call
(You must call the inspector when ready) Date Ready: 6I i 9I 9�
I, ❑'llcensed contractor ❑ owner hereby request inspection of the above electrical work at:
�b A���S�s���t, e�", o� R�t�r�..}.MORE C I R c�t'FR I DLEY Z�p 55432
Section No. Township Name w No. Range No. Fire No. County
ANOKA
Occupant Phone No.
DAVID M SARNA 788-5883
Power Supplier Address
NSP P[PLS OFF'ICE
Electrical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Ony)
liASTER ELECTRIC CO. , INC. CA01192
Mailing Address (Contractor or Owner Performing Installation)
12467 BOONE AVE S.SAVAGE MN. 55378
Authorized Signatu ractor or Owner Performing Installation) n A��� Phone No.
v d
94 —4712/890-355
EB-00001A-11 8/95 STATE BOARD COPV - SEE INSTRII(:TIONS ON RACK nF YFI I OW CfIPV �