P - 82840REQUEST FOR ELECTRICAL INSPECTION �TM��
`i lili�( I�I Illil Illli Iilll lil�) Illlt �ill/ lill IIII 1^g2leUni eS ity AVearRmf S1e 28cSt Paul, MN 55104 �.L �,. �
* * Phone (612) 642-0800 �'�`'�"%'�'"
03799152
Home Duplex Apt. Bldg. Other: �� �, C, New Addn
Commercial Industrial Farm Remod Repair
Air Cond. Htg. Equip. Water Htr. oad 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 only.
SAVER'S SWITCH INSTALLATIOAt
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 15. �'
Sign/Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool I hereby certify that I inspected the electrical installation described herein on the dates stated
rigation Boo ough-In oa�e
peciallnsp i
Fnal
Investigative Fee Z-^
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
- �-Y _ ��_ _
OFFICE USE ONLY This request void 18 months from validation date printed in this box.
379-91 � �f-� � y
'��- " JOB NUMHER #k970600
PLEASE PRINT OR TYPE
Request Da Rough-in inspection required? ❑ Yes ❑ N Inspection Other Than Rough-In: ❑ ady Now � Will Call
(You must call the inspector when ready) oate Ready: E� / i 9/ 98
I, ❑ icensed contractor ❑ owner hereby request inspection of the above electrical work at:
.�b i���t. B°", °` R�i��{ORY PL NE °ityF'R I DLEY Z�P �5432
Section No. Township Name or No. Range No. Fire No. County AHOKA
��P�AVID TEMPLE �oneNo. g44-2065
Power Supplier Address
NSP lIPLS OFFICE
Electrical Contractor (Company Name) Contractor License lJo. Master Lic. No. (P�ant Elect. Only)
liASTER ELECTRIC CO. , INC. CA01192
Mailing Address (Contractor or Owner Performing Installation)
12467 BOONE AVE S. SAVAGB lIN. 55378
Authwiz ignature (Contractw w Owner Perfwming Installation) Phone No.
26380 94 —4712/890-355
EB-00001A-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY