P - 83064lIII;�IIIII IIIII IIIII IIIII IIII! IIlII 1114I IIII IIII
*03$69989*
REQUEST FOR ELECTRICAL INSPECTION ��
Minnesota State Board of Electricity � °c
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800 �'�'—�
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Cond. Htg. Equip. Water Htr. oad Mgmt. Other:
Dryer Range Elec. Heat emp. Service
"X" above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
SAVER'S SWITCH INSTALLATION
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLV TOTAL
Sign/Outline Ltg. Xfmr. 1S.$m
Alarm/Remote o rol
Swimming Poo I hereby certify that I inspected the electricai installation described herein on the dates stated
Irrigation Boom Rough-In Date
pecial Inspection
F�� o
Investigative Fee " Z Z '
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 s from validation date printed in this box.
386-99� � �,s
,��/�
J�H NUMBER #9?0600
PLEASE PRINT OR TYPE
Request Da � 1 L� � 8 Rough-in inspection required? ❑ Yes ❑ N Inspection Other Than Rough-In: ❑ y Now � Will Call
(You must call the inspector when ready) Date Ready: 8I 14I98
I, ❑�ensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
01588 GARDEI�IA AVE NE FRIDLEY 55432
Section No. 7ownship Name or No. Rarx7e No. Fire No. County
ANOKA
Occupant Phone No.
ROGER P WILSON 586-9910
Power Supplier Address
NSP MPLS OF'F'ICE
Electrical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Eled. Only)
MASTER ELECTRIC CO.,INC. CA01192
Mailing Address (Con[ractor or Owner Pertorming Installation)
12467 BOONE AVE S. SAVAGE MH. 55378
Autho ' S' nature (Contractor or Owner Performing Installation) .� PFrone No.
r"' �G 6 94 —4712/890-355
EB-OOOOtA-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY