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*03923323*
REQUEST FOR ELECTRICAL INSPECTION ��
Minnesota State Board oi 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. X 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 onty.
SAVER'S �WITCH INSTALLATION
Calculate Inspection Fee - This /nspection Request will not be acc�ted without the correct fee:
Other Fee # Service Entrance Size Fee � CircuitsJFeeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg.lTraffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLV 70TA
Sign/Outline Ltg. Xfmr. • 5�
Alarm/Remote Control
Swimming Pool I hereby certify ihat I inspected ihe electrical installation described herein on the dates stated
Irrigation Boom Rough-In Date
X Speciallnsp �o ,,]. .,50 .
Rnal te � � �
Investigative /
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
„- M �t - - - - �,-�---- --� �-- ...,_ �._.,..�
OFFICE USE ONLY This request void 18 months from validation date printed in this box.
392-332�3] � �a� ���;
JOB HUMBER #9ffi06000
PLEASE PRINT OR TYPE
Requeft �aje 30 � 9B Rough-in inspection required? ❑ Yes �Oo Inspedion Other Than Rough-In: �( Ready Now ❑ Will Call
(You must call the inspector when ready) Date Ready: 1�, I 30I 98
I, �j licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, ar Raute No.) City Zip Code
0Q1520 GLEHCOE ST NE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
ANOKA
Occupant Phone No.
RICHARD E'RAHCIS BOYCE 717-6967
Power Supplier Address
MSP MPLS Of'F'ICE
Electrical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Ony)
MASTER ELECTRIC CO. , IHC. CA011'32
Mailing Address (Contractor or Owner Performing Installation)
12467 BOONE AVE S.SAVAGE h
Authorized Signature (Contractor or Owner Performing Installation) �-. ,�� Phone No.
EB-OOOOtA-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY