P - 83011lI!!II �III IIIII IIIII IIIII IIIII IIIII IIIII IIII IIII
*03798279*
REQUEST FOR ELECTRICAL INSPECTION �,��
Minnesota State Board of Electricity °i
1821 University Ave., Rm. S-128, St. Paul, MN 55104 �. :
Phone (612) 642-0800 �''�''��
Home Duplex Apt. Bldg. Other: �s New Addn
Commercial Industrial Farm �o �1.� Remod Repair
Air Cond. Htg. Equip. Water Htr. oad Mgmt. Other:
Dryer Range Elec. Heat emp. Service
"X" above the work covered by this requesi. Enter remarks in this space and on the back of the white copy only.
SAVER'S SWITCH IHSTALLATION
Calculate Inspection Fee - This Inspection Request will not be accepied without the conect 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 1 S��
Sign/Outline Ltg. Xfmr. �
Alarm/Remote Co 0
SwifllfTllfl9 POO� � I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom R«,9n-in Date
pecial inspection '
Investigative Fee Fnal D te 2„� ^�
THIS INSTALLATION MAY BE ORDERED DISC CTED IF NOT COMPLETED WITHIN 18 MONTHS.
� � OFFICE USE ONLY This request void 18 months from validation date printed in this box.
379-827� Ls� i
�� C
�—d"J �� JOB NUMBER #970600
PLEASE PRINT OR TYPE
Request Da Rough-in inspection required? ❑ Yes ❑ N Inspection Other Than Rough-In: ❑ ady Now ❑ Will Call
(You must call the inspector when ready) oate Ready: G/ i 9/ 98
I, ❑"�censed contractor ❑ owner hereby request inspection of the above electrical work at:
.�b `�I��S�.Cs���t, e°", o� R�iiA��ENA AVE NE c�''F'RIDLEY Z�P �5432
Sec[ion No. Township Name or No. Range No. Fire No. ��� ANOKA
Occupant Phone No.
liILI.IE M ENGEBRETSON 571-4575
Power Supplier Address
NSP MPLS OFF'ICE
Electrical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Only)
MASTER ELECTRIC CO.,INC. CA01192
Mailing Address (Contractor or Owner Performing Installation)
12467 BOONE AVE S. SAVAGE N. 553?8
Authorized (Contractor or Owner Performing Instaliation) � O� Phone No.
94 —4712/890-355
EB-00001A-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY