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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