P - 83604IIIIiII�IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII) Mg � Uo a SstOAve.LR� SR1C8,cSt PaPEMNION04 �����,�_
� * 0 3 9 2 4 1 0 7'"` Phone (612) 642-0800 '�����'"
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Cond. Htg. Equip. Water Htr. }C 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.
SAVfiR'S SWITCH INSTALLATIOH
Calculate Inspection Fee - This Inspection Request will not be accepted without the correci 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 TOTA�
Sign/Outline Ltg. Xfmr, 50
Alarm/Remote Control
SWill'1fT11flg POO � I hereby certify that I inspected the electrical installation described herein on the dates stated
IffigBtlOf1 BOO�71 Rough-In Date
X Special Inspection 1. 50
Investigative Fee F"'� �are^ � L_ q�
/
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.
392-41 Q � � 5 = �
la(
JOB NUMBER #9$06000
PLEASE PRINT OR TYPE
Reque�t �a� 30 � 98 Rough-in inspection required? ❑ Yes ❑�o Inspection Other Than Rough-In: [K Ready Now ❑ Will Call
(You must call the inspector when ready) Date Ready: 1 1 I 3QJ I
I, �`j licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Cade
01565 GARDENA AVE NE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. Counry
ANOKA
Occupant Phone No.
SUSAN M WICK 571-0685
Power Supplier Add2ss
N5P MPLS OFFICE
Electrical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Only)
MASTER ELECTRIC CO.,INC. CA01192
Mailing Address (Contractor or Owner Performing Installatio�)
i2467 BOONE AVE S.SAVAGE MN. 55378
Authorized Signature (Co actor or Owner Performing Installation) Phone No.
941 4712/89
� EB-OOOOtA-11 8/95 STATE BOA E INSTRUCTIONS ON BACK OF YELLOW COPY