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*03924081*
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. Load Mgmt. Other:
Dryer Range Elec. Heat emp. Service
"X" above the work covered by this request. Enter remaiks in this space and on the back of the white copy only.
SAVER'S SWITCH INSTALLATTOH
Calculate Inspection Fee - This Inspection Requesi 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. � 50
Alarm/Remote o r I
Swimming Po I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In Date
X Speciallnspection 1 . 50
Final D e
Investigative Fee �— Z/— �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTH .
. ^—.r� -------------�------ ... _—�—
OFFICE USE ONLY This request wid 18 rtanths from validation date prin[ed in this box.
392-408�] �.5-�
�
JOB NUMBER #9�06000
PLEASE PRINT OR TYPE
Reque� �ayc 30 ��g Rough-in inspection required? ❑ Yes ❑�o Inspedion Other Than Rough-In: [K Ready Now ❑ Will Call
(YOU must call the inspector when ready) Date Ready: 1 1 I 3�I98
I, � licensed contractor ❑ owner hereby request inspection of the above electrical work at:
.bb Address (Street, Box, or Route No.) Cit ZiP Code
�1346 HILLCREST DR NE F�kIDLEY 55432
Sedion No. Township Name or No. Range No. Fire No. County
ANOKA
Occupant Phone No.
PAUL G TUMMS 571-9573
Power Supplier Address
NSP MPLS OFFICE
Electrical Contractor (Comparry Name) Contractor License No. AAaster Lic. No. (Plant Elect. Ony)
MASTER ELECTRI� CO.,INC. CA01192
Mailing Address (Contractor or Owner Performing Installation)
12467 BOONE AVE S. SAVAGE MN. 55378
Authorized Signature (Contractor or ner Performing Instal Phone No.
� �'� 941 4712/890-3555
EB-00001A-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY