P - 84055� � REQUEST FOR ELECTRICAL INSPECTION ��,
I ,• (II�IIIIIIIIIIIIIIIIIIIIIIIIIIIIIII�IIIIIIIIIIIII 1n821eUnl essty A earRmf SI 128cSt. Paul, MN 55104 �_ �:
* 0 3 7 1 6 8 3 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 emp. Service ,
I "X" above the work covered by this request. Enter remarks in this �oace and on the back of the whife copy only. ,
SAVER'S SWITCH INSTALLATION
Calculate lnspection Fee - This Inspection Requesf will not be accepted withoui the correct tee:
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
Sign/Outline Ltg. Xfmr. iS. S0
Alarm/Remote Control
Swimming P r f'� I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boo ` Rough-In Date
K Speciallnspection 1 . 50
Final D
Investigative Fee - ( � '�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFICE USE ONLY This request void 18 months trom validation date printed in this box.
371-683 [� �
%P��! �► �� JOB NUMHE�t #9706000
PLEASE PRINT OR TYPE
Requ�f��t21'� � C3'� Rough-in inspection required? ❑ Yes [,MJO Inspection Other Than Rough-In: � Ready Now ❑ Will Call
(You must call the inspector when ready) Date Ready: �, 0I 1^I I�J%
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
01020 HATHAWAY LN NE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
ANOKA
Occupant Phone No.
RICHARD A RAMACHER 574-2699
Power Supplier Address
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)
(Contractor or Owner Performing Installation)
� �
EB-0000 - 1 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY