P - 83673� REQUEST FOR ELECTRICAL WSPECTION �;�,
I . fI�III�I�IIIIIIIIIIIIIIIIIIIIIIII�lllllllllllllll 1�g21eUnivessty A earRmf SI 128cSt. Paul, MN 55104 �.� �
* 0 3 6 3 9 1$ 4* Phone (612) 642-0800 �'�'°
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod Repair
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. 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 INSTALLATION
Calculate In$neciion Fee - This Inspection Requesi 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 INSPECTOR'S USE ONLY TOTAL5 �
Sign/Outline Ltg. Xfmr. 1 �
Alarm/Remote Control 1 S � ��
Swimming Pool I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In Date
Speciallns nr c�
Final � �'7 /� �
Investigativ / �
� 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.
363-918� ��38 �
�S�S�
JOB NUMHER #�9?06000
PLEASE PRINT OR TYPE
Request a� 1 � Rough-in inspection required? ❑ Yes o Inspection Other Than Rough-In: Ready Now ❑ Will Call
��, (You must call the inspector when ready) Date Ready: % I 1% I 9%
I, }� licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) Cit Zip Code
00136 GIBRALTAR RD F�?IDLEY 55421
Section No. Township Name or No. Range No. Fire No. County
ANOKA
Occupant Phone No.
STEPHEN J PREVETT 5'71-6746
Power Supplier Address
NSP MPL.S OF'PICE
Electrical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Only)
MASTEii ELECTRIC CO. , INC. CA01192
Mailing Address (Contractor or Owner Performing Installation)
12467 HOONE AVE S. SAVAGE liN. 55378 I,
Auth � d Signature ( ntractor or wner Performing Install Phone No.
���� � � 941 4712/890-3555
EB-00001A-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY