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*03923877*
REQUEST FOR ELECTRICAL INSPECTION ���
Minnesota State Board of Electricity �
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 remarks in this space and on the back of the white copy only.
SAVER' S S4TITCH ITISTALLATION
Calculate Inspection Fee - This /nspection Request will not be accepted without the conect fee:
Other Fee # Service Entrance Size Fee n 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 ONLV TOTAy E� 50
l�
Sign/Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming r I hereby certify that I inspected the electrical installation described herein on the dates stated
Irrigation Boom Rough-In Date
Speciallnspection '
Investigative Fee Final Da + 2/
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
-_ _.r,F r ,--- _r— � .
OFFICE USE ONLY This req�st voitl 18 months from validation date printed in this box.
392-387 � /�is �
JOB HUMBER #9�06000
PLEASE PRINT OR TYPE
R� Rough-in inspection required? ❑ Yes ❑ o Inspection Other Than Rough-In: Ready Now ❑ Will Call
(You must call the inspector when ready) Date Ready: 11 / 30 / 9$
I, licensed contractor ❑ owner hereby request inspection of the above electrical work at:
�ot�r�s�(s5treet, eoX, o�t��r�,�ON DR NE �'� I DLEY Z�P�421
Section No. Township Name a No. Range No. Fire No. ��h' ANOKA
����I M NOVITSKY P��N� S%Z—.104%
Power Supplier Address
NSP MPLS OPFICE
Electrical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Eled. Ony)
MA�TER ELECTRIC CO.,INC. CA01192
Mailing Address (Contractor or Owner Perfaming Installation)
12467 BOOHE AVE S. SAVAGE MM. 55378
Au[Fwrized Signatu ntractor or Owner Per{prnipp Installation) Phone No.
'V 6 < <` 941 4712/890-3555
EB-00001A-11 8/95 STATE BOARD COPY - SEE INSTRUCTIONS ON BACK OF YELLOW COPY