P - 84054' I�h'il IIIII IIIII IIIII I 1 II I
.r ( II III I(IIII IIIII II I IIII
*03716735*
Home Duplex A{
REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone(612)642-0800
Other: New
�ommercial Industrial Farm Remod
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
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 conect fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200_Amps Above 100 Am
���a,
��.,��
� A�
Fee
Transformer/Generator INSPECTOR'S USE ONLY TOTA�S. 50
Sign/Outline Ltg. Xfmr. 1
Swimming Po¢�i tj I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In oate
Special Inspection �
Final D e�
Investigative Fee —
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS�
OFFICE USE ONLV This request void 18 months from validation date printed in this box.
371-673 [� ��J
����q� �
JOB NUMBER #9706000
PLEASE PRINT OR TYPE
Requ e Rough-in inspection required? ❑ Yes o Inspection Other Than Rough-In: �
(You must call the inspector when ready) Date Ready:
I, licensed contractor ❑ owner hereby request inspection of the above electrical work at:
�o��� �treet, Box, o7,F{pyJ4 N0.L A N N C I R H E �'�t I DLE Y
1�lisl.1S11
Section No. Township Name or No. Range No. Fire No. County
ANOKA
Ready Now ❑ Will Call
10/17/97
Z"��432
Occupant Phone No.
PAUL J NYHOLM 572-2070
Power Supplier Address
HSP liPLS 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 B. BAVAGE ![N. 5537$
Auth z i ture (Contractor or Owner Performing Installation) ,.,_ Phone No.
2c� % '� 941 4712/890-3555
EB-00001 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY