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*Q3716404*
REQUEST FOR ELECTRICAL INSPECTION �`�;
Minnesota State Board of Electricity � °i
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 Temp. Service
"X" above the work cove�ed by this request. Enier remarks in this space and on the back of the white copy only.
SAVER'S SWITCH INSTALLATIOH
Calculate Inspection Fee - This Inspection Request will not be accepted 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 TOTAL
Sign/Outline Ltg. Xfmr. 15. J0
Alarm/Re ro I-;-
Swimming Pool I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In Date
X Special Inspection 1, . S0
Final Da C'.�/
Investigative Fee � � — /,J�
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.
37� -s4o [� �
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JOB NUMBER �9706000 I
PLEASE PRINT OR TYPE
Requa�t,ga�1.7 �9,7 Rough-in inspection required? ❑ Yes f'k1Jo Inspection Other Than Rough-In: 17� Ready Now ❑ Will Call
1 VJ 1S '7i
(You must call the inspector when ready) Date Ready:
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
0�69Q► HELENE PL NE FRIDLEY 55432
Section No. Township Name or No. Range No. Fire No. County
AHOKA
Occupant Phone No.
ELLIS D GRIF'FITH 571-6484
Power Supplier Address
NSP MPLS OFFICE
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)
Aut i Si ture (Contractor or Owner Performing Installation) Phone No.
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EB-00 1A-1 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY