P - 83063I �I�III�IIII �I�II I�I�I �I�II IIII� I�III IIIII (III IIII
*03869930*
REQUEST FOR ELECTRICAL WSPECTION �,��,
Minnesota State Board of Electricity � �'
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800 �'�-�
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Cond. Htg. Equip. Water Htr. ad Mgmt. Other:
Dryer Range Elec. Heat emp. Service
"X" above the work cove�ed by this request. Enter remarks in this space and on the back of the white copy only.
SAVER'S SWITGH INSTALLATION
Calculate Ins�nection Fee - This lnspeciion Request will not be accepted without the correct tee:
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 15. �0
Sign/Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Poo i I hereby certiy that I inspected the elec[rical installation described herein on the dates stated
Irrigation Boom Ra,9r,-i� Date
peciallnspection •
Final D �
investigative Fee � � Z .� �'
THIS INSTALLATION MAY BE ORDERED DISC NECTED IF NOT COMPLETED WITHIN 18 MONTHS.
— — 1
386�V� ��CE USE ONLY This request void 18 � from validation d� printed�s box.
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JOB NUMBER �t970600
PLEASE PRINT OR TYPE
Request 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: 8I 1�i I g8
I, ❑'I1Gensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Gode
01400 FIRESIDE DR NE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. Counry
ANOKA
Occupant Phone No.
ALEK R THEOBALD 540-1364
Power Supplier Address
NSP MPLS OFFICE
Electrical Contractor (Company Name) Contractor License No. Masier Lic. No. (Plant Elect. Only)
MASTER ELECTRIC CO.,INC. CA01192
Mailing Address (Contractor or Owner Performing Installation)
12467 S�OHE AVE S. SAVAGE MN. 55378
Authorized Si a ure (Contractor or Owner Performing Installation) � Phone No.
94 -4?12/890-355
EB-00001A-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY